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650 Cards in this Set
- Front
- Back
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What does the HEEADSSS mnemonic represent?
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Adolescent screeing tool- Home environment; Education, employment; Eating; Activities (peer-related), affect, ambitions, anger; Drugs; Sexuality;Suicide/depression;Safety from injury and violence
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What does the PACES mnemonic represent?
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Adolescent screening tool- Parents, peers; Accidents, alcohol/drugs; Cigarettes; Emotional issues; School, sexuality
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When should an infant recognize the face of a primary caregiver?
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by 2 months
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What should be the concern is unable to coax a social smile?
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meningitis,neurologic condition, or infection
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When should an infant show a social smile?
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by 2-3 months
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When should an infant coo and babble?
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after 3 and 4 months of age respectively
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What type of cry should the cause you to suspect CNS deficit?
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A shrill or whiny high-pitched cry or catlike screeching cry
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How old should be the child that can at least repeat three digits or words?
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4 y/o
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How old should be the child that can at least repeat four digits or words?
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5 y/o
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How old should be the child that can at least repeat five digits or words
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6 y/o
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When should a child be able to have one to two words like mama or bye-bye?
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10 to 12 months
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When does a child start to increase his/her words each month, and use two word combinations?
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12-24 months
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When can we expect 2 to 3 word sentences to ask for things, and have the speech understood by at least family members?
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24 to 36 months
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When can the speech of a child be understood by most people and they can also talk in sentences of more than 4 words?
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36 to 48 months
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When can a child tell stories with the same grammar as the family?
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48 to 60 months
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What is the Denver II tool used for?
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determining whether the child is developing gross motor skills, language, and personal-social skills
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What is the Goodenough-Harris drawing test used for?
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for the assessment of the cognitive development of an older child
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When can recent memory be tested in an older child?
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at 5 to 6 y/o; show them familiar objects wait five minutes, then ask them to recall the objects
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What are the deficits of mental retardation?
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Subaverage general cognitive functioning and deficits in adaptative behavior
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What are the characteristics of mental retardation?
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delayed developmental milestones(motor,speech, language); impaired cognitive function and short-term memory; inability to discriminate between two or more stimuli; lack of motivation
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What neurochemical imbalances have been attributed to ADHD?
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dopamine
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When can recent memory be tested in an older child?
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at 5 to 6 years
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What are the signs of impaired attention in ADHD?
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short attention span, difficulty organizing tasks , fails to complete school assignments or follow instructions ( occurs in more than one setting)
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What are the signs of hyperactivity in ADHD?
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poor impulse control, temper outbursts, talks excessively, disruptive behavior, increased motor activity, Fidgets and squirms
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When is autism usually diagnosed?
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before the age of 3
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How is motor development affected in autism?
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It is appropriate for age
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How is play affected in autism?
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Ritualized play; Impaired symbolic and imaginative play; preoccupation with parts of objects
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Describe the social interaction of an autistic child?
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Does not make eye contact or point for the purpose of sharing experiences with others; resists being held or touched; lack awareness of others; odd and repetitive behaviors
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Describe the speech of an autistic child?
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Odd intonation to speech, pronoun reversal, nonsensical rhyming
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What is vernix caseosa?
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a mixture of sebum and cornified epidermis, covers the infant's body at birth
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Describe the eccrine and apocrine glandular activity in an infant.
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The eccrine glands start to function after the first month of life; there is no apocrine function
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Describe the eccrine and apocrine glandular activity in an adolescent.
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Sebaceous glands increase sebum production in response to increased hormone levels (mainly androgen); Apocrine glands enlarge and become active --> increased ab
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Desquamation of the ______ may be present at birth or shortly after.
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stratum corneum
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What is the lanugo?
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Fine, silky hair that covers the newborn's shoulder and back; it is shed in 10 to 14 days
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Cutis marmorata is the transient mottling when the newborn is exposed to _____ temperature.
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decreased
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Where you should for the true melanosis in dark- skinned newborns?
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In the nail beds and skin of scrotum
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Where should you look for Mongolian spots in dark- skinned newborns?
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In the sacral and gluteal regions;
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Who are more likely to have irregular areas of deep blue pigmentation?
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Mongolian spots; African, Native American/American Indian, Asian, or Latin descent
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What are the lesions commonly known as "stork bites"?
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also known as salmon patches; flat, deep pink localized areas usually seen on the mid-forehead, eyelids, upper lip and back of neck
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What is the viral agent in erythema toxicum?
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NONE; It is an expect color change in the newborn!
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Describe erythema toxicum.
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Pink papular rash with vesicles superimposed on thorax, back, buttocks, and abdomen; may appear in 24 to 48 hours and resolves after several days.
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What body locations more readily display jaundice on a newborn?
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oral mucosa and sclera of the eyes
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What percentage of newborns display physiologic jaundice?
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50%
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When should we expect physiologic jaundice to develop and to resolve?
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Usually starts after the first day of life and disappears by the 8th to 10th day- may persist for as long as as 3 to 4 weeks
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What conditions are associated with café au lait macules?
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neurofibromatosis, pulmonary stenosis, temporal lobe dysrhythmia, and tuberous sclerosis
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Café au lait macules are flat, evenly pigment spots greater than _____in diameter.
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5 mm
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What abnormalities are associated with facial port wine stain associated with ophthalmic division of trigeminal nerve?
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may be associated with ocular defects (like glaucoma); Sturge-Kalischer-Weber syndrome (angiomatous malformation of the meninges resulting in atrophy and calcification of the adjacent cerebral cortex.
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What skin lesions are associated with Sturge-Kalischer-Weber?
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Facial port wine stain
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What abnormalities are associated with limb/trunk port wine stain ?
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When accompanied by varicosities and hypertrophy of underlying soft tissues and bones( Kippel-Trenaunay-Weber)
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What chromosomal abnormality is associated with congenital lymphedema?
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Turner syndrome ; XO karyotype- with gonadal dysgenesis ; the congenital lymphedema can be seen w/ or w/o transient hemangiomas
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What is an ash leaf macule and what conditions are associated with it?
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White macules that commonly are on the trunk, but also appear on the face and limbs- assoc with Tuberous sclerosis
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describe epidermal verrucous nevi.
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Warty lesions in a linear or whorled pattern that may be patterned or skin colored; these are associated with skeletal, CNS and ocular abnormalities
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What is a faun tail nevus?
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A tuft of hair overlying the spinal column at birth, usually in the lumbosacral area; associated with spina bifida occulta
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What condition is associated with axillary/inguinal freckling?
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neurofibromatosis
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What are the supernumery nipples often associated with?
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renal abnormalities, especially in the presence of other minor anomalies, particularly in whites
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What skin lesions are associated with Kippel-Trenaunay-Weber?
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limb/trunk port wine stain
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What gestation period is associated with hyperbilirubinemia?
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gestation less than 39 weeks
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Exclusive ___ feeding in a newborn is associated with hyperbilirubinemia?
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breast
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What is the "hair collar sign"?
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A ring of dark coarse hair surrounding a midline scalp nodule in infants --> indicates neural tube closure defect of the SCALP
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A mature newborn should have ____ creases than a premature baby.
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more
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What abnormality is a single transverse crease in the palm associated with?
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This is a Simian crease, it is associated with Down Syndrome
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Why are newborns more susceptible to hypothermia?
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Partly due to a poorly developed subcutaneous fat ,large body surface area and an inability to shiver.
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What is commonly associated with cutis marmorata?
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premature infants; children with Down syn or hypothyroidism
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What is the time limit that we give to puffiness of the hands, feet, eyelids , legs, pubis, or sacrum before getting further workup?
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It disappears within 2 to 3 days.
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What is the NIH criteria for diagnosing nuerofibromatosis?
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NF-1, includes 6 or more café au lait macules more than 5 mm in greatest diameter in prepubertal individuals or more than 15 mm in greatest diameter after puberty.
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When should acrocyanosis of a newborn start to suggest an underlying cardiac or pulmonary defect?
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When the cyanosis persists and is more intense in the feet than in the hands
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Superficial and subcutaneous hemangiomas develop in the first ____ months, grow for ____ months and regress over the next_______.
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1-2 months; 2-6 months; 5 to 10 years
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What are milia?
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Small whitish discrete papules on the face; commonly found during first 2 to 3 months; these are immature sebaceous glands that easily plugged with sebum
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Sebaceous hyperplasia is caused by ______ stimulation from the mother.
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androgen
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What does sebaceous hyperplasia look like in a newborn?
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As numerous tiny yellow macules and papules; commonly on the forehead, cheeks, nose, and chin of the full-term infant; should resolve in 1 to 2 months of life
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Where should tissue turgor be tested?
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on abdomen
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When it takes about 2 to 3 seconds for the tenting to resolve, what is the degree of dehydration that we can presume?
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5% to 8% loss of body weight
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When it takes about 3 to 4 seconds for the tenting to resolve, what is the degree of dehydration that we can presume?
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9% to 10% loss of body weight
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Over 10% loss of body weight indicates _____ seconds of turgor.
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over 4 seconds
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What areas are known to demonstrate seborrheic dermatitis?
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It is localized in areas where sebaceous glands are concentrated ie scalp, back, intertriginous, and diaper areas
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Describe the rash of seborrheic dermatitis.
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scalp lesions are scaling, adherent, thick, yellow, and crusted and can spread over the ear and down the nape of the neck; lesions elsewhere are erythematous, scaling and fissured
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Milia is due to clogged ____ and miliaria is due to clogged___
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sebaceous glands; sweat ducts
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When is the rash of miliaria common?
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During periods of heat and high humidity; summer- common in overdressed infants
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describe the rash of miliaria.
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irregular, red, macular rash usually on covered areas on the skin
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Causative agent of impetigo.
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staphylococcal
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What is the initial lesion of impetigo? What does the resolving rash look like?
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The initial lesion is a small erythematous macule that changes into a vesicle or bulla with a thin roof. The lesion crust with a characteristic honey color from the exudate as the vesicle or bullae
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How do inflammatory papules develop in acne vulgaris?
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When the wall of the closed comedo may rupture, spilling the follicular contents into the dermis, leading to the development of inflammatory papules
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Androgens stimulate the ______ to enlarge and produce the large amounts of sebum.
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pilosebaceous units
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What is the causative agent for inflammatory response in acne?
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the presence of P. acnes
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What is the period of communicability of chickenpox?
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from one to two days BEFORE the onset of the rash until lesion have crusted over
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What is the incubation period in chicken pox?
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two to three weeks
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What are the complications of chickenpox?
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Conjunctival involvement, secondary bacterial infection, viral pneumonia, encephalitis, aseptic meningitis, myelitis, Guillain-Barre syndrome, and Reye syndrome
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What is the evolution of the varicella rash?
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Pruritic rash that started on the scalp and then moved to extremities; starts maculopapular and in a few hours became vesicular; lesion usually occur in successive outbreaks with several stages of maturity present at one time.
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Measles is also known as ____
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rubeola; hard measles; red measles
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What are the typical symptoms of measles?
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characteristic prodromal fever, conjunctivitis, coryza,and bronchitis occur; followed by a red, blotchy rash first on the face and then spreading to the trunk and extremities
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Describe the rash of measles.
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Macular rash develops on the face and neck
Maculopapular lesions on the trunk and extremities in irregular confluent patches Rash lasts 4 to 7 days |
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What is the period of communicability of measles?
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the period of communicability last from a few days before the fever to 4 days after the appearance of the rash
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What is the incubation period of measles?
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commonly 18 days
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What tissues are infected by measles?
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Measles virus infects by invasion of the respiratory epithelium. Local multiplication at the respiratory mucosa leads to a primary viremia, during which the virus spreads in leukocytes to the RES. Both endothelial and epithelial cells are infected
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What is the incubation period of german measles?
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14 to 23 days
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What is the period of communicability of german measles?
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Patients are most contagious while the rash is erupting, but they may shed virus from the throat from 10 days before until 15 days after the onset of the rash.
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Describe the rash of german measles.
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Macular rash on the face and trunk that rapidly becomes papular
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What is the development of the rash in german measles?
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Macular rash on the face- the presence of red palatal lesions (Forschheimer spots) can be seen on day one ; by the second day, rash spreads to the upper and lower extremities; it fades within 3 days
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When during pregnancy can the fetus be infected with german measles?
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first trimester
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Describe the pattern of hair loss in trichotillomania.
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affected area has an irregular border, and hair density is greatly reduced but the site is not bald.
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What is the bruise pattern that is atttributed to abuse?
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Occurs over soft tissue; occurs in an infant that is not developmentally able to be mobile should be cause for concern
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What is the pattern to burns likely caused by abuse?
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Scald burns in stocking and glove distribution; buttock burns consistent with immersion; cigarrete burns in areas normally covered by clothing
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Lacerations on the lips of a newborn could indicate ______
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forced feeding.
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When does the immune system and the lymphoid system begin developing?
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at 20 weeks of gestation
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Is the ability to make antibodies present at birth?
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no
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When is the thymus the heaviest?
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At puberty
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If you find an occipital node in a 1 year old, is it significant?
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No, before 2 years of age, inguinal, occipatal, and postauricular nodes are common
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The presence of which nodes are highly indicative of malignancy?
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Supraclavicular
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If you find an cervical node in a 1 year old, is it significant?
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Yes, cervical and submandiubular nodes are uncommon in the first year
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Should a rapidly growing lymph node in a one year old be cause for a further workup?
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Yes, any lump that grows rapidly and insistently in any age should get further investigation
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How can you differentiate between cervical adenitis and mumps?
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A cervical adenitis does not obscure the angle of the jaw. Mumps causes a painful swelling of the parotids that can obscure the angle of the jaw
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Where do rubella, rubeola, varicella, Hepatitis A or B, and infectious mono normally have lymphadenopathy?
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posterior cervical
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When do the ossification of the sutures begin?
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at 6 years
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When does the anterior fontanel close?
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24 months
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When does the posterior fontanel close?
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2 months
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In the male adolescent, the ____ and ____ cartilage enlarge.
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nose and thyroid cartilage
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What is caput succedaneum?
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"It is subcutaneous edema over the presenting part of the head at delivery.the affected part feels soft and the margins are poorly defined"
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What is cephalhematoma?
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"A subperiosteal collection of blood that is commonly found in the parietal region. It is firm and its edges are well-defined"
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How can you tell the difference between caput succedaneum and cephalhematoma?
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Cephalhematoma is bound by the suture lines but caput succedaneum usually over the occiput and crosses suture lines
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What are some reasons for plagiocephaly?
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"Plagiocephaly is flattened spot on the back or the side of the head. It can result from premature fusion of the one of the sutures (craniosynostosis) or from external deformation (positional )"
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Describe brachiocephaly, what is it caused by
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In preterm infants often have long, narrow heads because their soft cranial bones become flattened with positioning and the weight of the head
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What is bossing of the skull?
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bulging of the skull
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in newborns, what is the expected measurement of the anterior fontanel?
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4 to 5 cm
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When is a mastoid fontanel common?
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In infants with Down syndrome;
located between the anterior and posterior fontanels |
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When should a newborn regain the symmetry of their head after birth?
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in one week
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What should we suspect with a bulging fontanel with marked pulsations?
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Indicates increased intracranial pressure from a space-occupying mass or meningitis
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What are some causes of craniotabes?
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"Craniotabes is a softening of the outer table of the skull.It can be associated with prematurity, rickets, hydrocephalus, syphilis"
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With tranillumination of the skull, what are expected findings for a normal baby?
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A ring of 2 cm or less beyond the rim of the transilluminator is expected on all regions of the head except the occiput where the ring should be 1 cm or less
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What is Macewen sign?What does it indicate?
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Direct Percussion of the skull near the junction of the frontal, temporal, and parietal bones that produces a stronger resonant sound when either hydrocephalus or a brain abscess
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what do Cranial bruits usually indicate in a child under 5 years of age?
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These are common; they can also indicate anemia
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What do Cranial bruits usually indicate in a child over 5 years of age?
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Vascular anomalies or increased intracranial pressure
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what is an encephalocele
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neural tube defects with protrusions of brain and membranes that cover it through openings in the skull
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What is the expectation for microcephaly
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head circumference is 2 to 3 standard deviations below mean for age
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In positional molding, where would you expect to see bossing?
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Contralateral occiptal bossing, ipsilateral ear displaced anteriorly
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Would you expect to find mental retardation with craniostenosis or with craniosynostosis?
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Craniostenosis causes microcephaly and is associated with mental retardation and failure of the brain to develop normally
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With unilateral lamboid synostosis, where would you expect to see bossing?
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"ipsilateral occipitomastoid bossing, contralateral parietal bossing"
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What is craniosynostosis?
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the premature closing of one or more cranial sutures before brain growth complete- skull growth restricted perpendicular to fused suture
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what head shape is expected with lamboid craniosynotosis?
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trapezoid- like shaped head
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when do the eyes develop embryologically?
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at the first 8 weeks of gestation
the eyes may be malformed due to maternal drug ingestion or infection during this time |
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describe the vision of a term infants
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"term infants are hyperopic, with a visual acuity of less than 20/400
Peripheral vision is fully developed at birth central vision matures later" |
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when can an infant differentiate colors?
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by 6 months
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when is binocular vision complete in an infant?
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by 3 - 4 months
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when is adult visual acuity reached in the child?
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at 4 years of age
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when is the lacrimal gland fully functional in a child?
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"by 2 -3 weeks of age, the lacrimal gland begins producing full volume of tears. Lacrimal drainage is complete at birth"
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how do you detect epicanthal folds?
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look for a vertical fold of skin nasally that covers the lacrimal caruncle
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How do you determine a Mongolian slant?
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Draw an imaginary line through the medial canthi and extend the line past the outer canthi of the eyes. When the outer canthi are above the line- an upward mongolian slant is present
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How do you determine an anti Mongolian slant?
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Draw an imaginary line through the medial canthi and extend the line past the outer canthi of the eyes. When the outer canthi are BELOW the line- an downward antimongolian slant is present
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What does the sunsetting sign indicate?
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"Although a common variant in newborns, it may be observed in newborns with hydrocephalus and brainstem lesions
to detect the sunsetting sign , you rapidly lower the baby from an upright to a supine position and look for the sclera above the iris" |
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what is hypertelorism
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"wide spacing of the eyes
may be associated with cranial defects including some with mental retardation" |
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Enlarged corneas can indicate ____.
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congenital glaucoma
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How can you grossly exam the vision in an infant?
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Observe the infant's preference for looking at certain objects. Expect the infant to focus on and track a light or face through 60 degrees.
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What can cause pseudostrabismus?
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caused by a flattened nasal bridge or epicanthal fold; usually disappears by about one year of age
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how do you differentiate from pseudostrabismus and strabismus
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use the corneal light reflex --> asymmetric light reflex indicates true strabismus
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what is coboloma
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keyhole pupil that is often associated with other congenital abnormalities
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what disease does the presence of brushfield spots represent?
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these are white specks scattered in a linear pattern around the entire circumference of the iris. They strongly suggest Down syndrome
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what is the optical blink reflex?
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when a bright light is shone at the infant's eyes and noting the quick closure of the eyes and dorsiflexion of the head
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when is a fundoscopic exam normally conducted in a newborn?
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When the infant is 2 to 6 months of age
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what is the anticipated visual acuity for children aged 3 to 5 years
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20/40 or better
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How should you dilate a blue- eyed infant's eyes?
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With a weak solution of cyclopentolate hydrochloride 0.5%- with one drop each
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How should you dilate a dark- eyed infant's eyes?
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With a weak solution of cyclopentolate hydrochloride 0.5%- with one drop each then add a second drop 5 minutes later
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What could cause opacities of the red reflex?
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congenital cataracts or retinoblastoma
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What is the anticipated visual acuity for children aged 6 years
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20/30 or better
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When should you start testing visual acuity?
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Usually at age 3 years old
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When conducting a visual acuity test for a 4 year old you notice a three line difference between the two eyes, but they are technically in the passing range. Is this concerning?
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Yes. Refer to a specialist
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What are the retinal signs of retinoblastoma?
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ill- defined mass arising from retina on fundoscopic examination; chalky-white areas of calcification
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What is leukocoria?
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"The initial sign of retinoblastoma
A white reflex instead of the usual red reflex" |
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What group of infants has the highest incidence of retinopathy of prematurity?
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60% of infants less than 750 grams
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What are the fundoscopic findings of retinopathy of prematurity?
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straight, temporally diverted bood vesselss
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When should you refer an infant for screening for retinopathy of prematurity?
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"Birth weight less than 1500 grams
Gestational age less than 32 weeks Birth weight between 1500 and 2000 grams with unstable clinical course" |
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What are the retinal signs associated with child abuse?
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Bilateral retinal hemorrhages
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When does embryological development of the inner ear occur?
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The 1st trimester
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What action restricts food from entering the nasopharynx?
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muscles in the pharynx contract and prevent movement of the food into the nasopharynx
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When do the frontal and sphenoid sinuses develop?
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at 3 years old
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What are the anatomical differences between a child and an adult's Eustachian tube?
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The infant's Eustachian tube if relatively wide, shorter, and more horizontal than an adult's --> this allows easier reflux of nasopharygneal secretions
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At what age do deciduous teeth appear?
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between 6 and 24 months of age
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When do permanent teeth begin forming?
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by 6 months of age
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When do permanent teeth erupt?
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at 6 years of age
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What are possible occlusions for the middle ear in a child?
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growth of lymphatic tissue, (specifically the adenoids)
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When is the eruption of the permanent teeth usually complete?
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around 14-15 years old
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|
What birth weight predisposes to hearing loss?
|
1500 grams
|
|
|
What perinatal infections predispose for hearing loss?
|
bacterial meningitis, recurrent episodes of acute otitis media or otitis media with effusion
|
|
|
What metabolic conditions predispose for hearing loss in infants and children?
|
severe hyperbilirubinemia
|
|
|
A bifid uvula could be an indication of ______.
|
submucous cleft palate
|
|
|
What is the appearance of tonsilitis?
|
reddened, hypertrophied, covered with exudate
|
|
|
What are the expected physical findings with suspected post nasal drip?
|
Yellowish mucoid film in the pharynx
|
|
|
What are the expected physical findings with peritonsillar abscess?
|
A red bulge adjacent to the tonsil and extending beyond the midline
|
|
|
What is the difference between the auricle of a premature and a mature newborn?
|
The newborn's auricle is very flexible with instant recoil after bending. The premature infant's auricles may appear flattened with limited incurving of the upper auricle and ear recoil is slower.
|
|
|
How do we determine low set ears in the newborn?
|
the tip of the auricle should cross the imaginary line between the inner canthus of the eye and the prominent portion of the occiput- it should vary no more than 10 degrees from vertical
|
|
|
How do you best visualize the newborns tympanic membrane?
|
Pull the auricle down to straighten the upward curvature of the canal.
|
|
|
What is the typical appearance of the tympanic membrane in a newborn?
|
It is usually in an extremely oblique position with a diffuse light reflex
|
|
|
What nose shapes may indicate chromosomal abnormality?
|
A saddle shaped nose with a low bridge and broad base; a small short nose; or a large nose
|
|
|
What are some causes for an obstructed naris in a newborn?
|
Choanal atresia or stenosis, septal deviation resulting from delivery trauma
|
|
|
What concerns should you have in a one year old that is actively drooling?
|
Normal variant; Usually occurs with teething
|
|
|
What concerns should you have in a three year old that is actively drooling?
|
Potential neuro or oral motor disorder; anomalies of the teeth or UGI tract
|
|
|
What is tongue tie?
|
When the tongue does not protrude beyond the alveolar ridge- this can cause feeding difficulties.
|
|
|
What is the appropriate placement for the frenulum of the tongue?
|
It usually attaches at a point midway between the ventral surface of the tongue and its tip
|
|
|
What are Epstein pearls?
|
They are small, whitish- yellow masses at the juncture between the hard and soft palate. They disappear within a few weeks after birth.
|
|
|
Who are most likely to have recurrent acute otitis media?
|
children with craniofacial anomalies and Down syndrome
|
|
|
When can the Weber and Rinne tests be used in a child?
|
Usually at age 3 to 4 years old
|
|
|
What should be suspected with mottled or pitted teeth?
|
enamel dysplasia; tetracycline treatment during tooth development
|
|
|
What should be suspected with black or gray colored teeth?
|
pulp decay or oral iron therapy
|
|
|
What are the clinical signs of group A beta-hemolytic strep?
|
"Tonsillar enlargement and exudates
Tender and enlarged cervical nodes Pharyngeal erythema" |
|
|
What age do you expect a child to respond to their name
|
7 to 12 months
|
|
|
When does a child begin to respond to a parent's voice?
|
4- 6 months
|
|
|
When do you expect a child to startle to loud noises
|
from birth to 3 months
|
|
|
Newborns are _____ nose breathers
|
obligatory
|
|
|
When do you expect drooling as a normal occurrance in an infant?
|
from 6 weeks to 6 months
|
|
|
Where should expect to find retention cysts
|
In a newborn, pearl-like retention cysts are found along the buccal mucosa margin and should disappear in 1-2 months
|
|
|
What conditions are macroglossia associated with?
|
Congenital hypothyroidism
|
|
|
What age do you expect maxillary sinuses to develop?
|
4 years of age
|
|
|
What age do you expect frontal sinuses to develop?
|
5 -6 years of age
|
|
|
What is bruxism?
|
"Flattened edges on the teeth
This may indicate compulsive , unconscious grinding of the teeth" |
|
|
The appearance of chalky white lines and speckles on the cutting edges of permanent incisors indicate excessive iron or fluoride therapy?
|
Fluoride therapy
|
|
|
what do the presence of Koplik spots indicate?
|
"Rubeola
They are white specks with a red base on the buccal mucosa opposite the first and second molars" |
|
|
What is difference between +3 and +4 tonsillar enlargement?
|
"3+ nearly touching the uvula
4+ touching each other" |
|
|
How does eustachian tube obstruction lead to middle ear effusion?
|
The Eustachian tube may be dysfunctional or obstructed by enlarged lymphoid tissue in the nasopharynx, causing the middle ear to absorb the air and create a vacuum; the middle ear mucosa secretes a transudate
|
|
|
What is the precipitating event in otitis externa?
|
Water retained in the ear canal that causes tissue maceration , desquamation and micro fissures that favor bacterial or fungal growth
|
|
|
What is the appearance of the tympanic membrane with acute otitis media vs otitis media with effusion?
|
"In acute otitis media, the bulging TM has a distinct erythema with thickening or clouding
In Otitis media with effusion the TM may be retracted or bulging" |
|
|
What is the difference between +1 and +2 enlarged tonsils?
|
1+ indicates that they are visible but 2+ indicates that they are halfway between tonsillar pillars and the uvula
|
|
|
How do we identify the uvula in the mouth?
|
When the tongue is depressed, the epiglottis is visible as a glistening pink structure behind the base of the tongue
|
|
|
What is the peak size of the tonils reached?
|
They are enlarged to their peak size by about 6 years of age
|
|
|
When observing a tonsil that is pushed forward, displacing the uvula- what should we suspect?
|
Peritonsillar abscess or mass
|
|
|
Describe the lung structure at 4 weeks gestation.
|
The lung is a groove on the ventral wall of the gut
|
|
|
What is the role of the passive movements of the lung during gestation?
|
They prepare the term infant to respond to postnatal chemical and neurological respiratory stimuli
|
|
|
How much does the passive respiratory movements open the alveoli and lung fields?
|
They do not open the alveoli or move the lung fields
|
|
|
In a child, when is the fastest rate of lung development?
|
The first 2 years
|
|
|
What are the changes to the pulmonary arteries immediately after birth?
|
The pulmonary arteries expand and relax
|
|
|
What stimulates the closure of the foramen ovale
|
The decrease in pulmonary vascular pressure
|
|
|
What stimulates the closure of the ductus arteriosus?
|
The increased oxygen tension in the arterial blood usually stimulates the contraction and closure of the ductus arteriosus
|
|
|
In the chest of a newborn, the AP diameter is _____ the lateral diameter. The circumference is ______ to the head circumference.
|
equal; equal
|
|
|
A heart rate of 80 earns an Apgar score of ____
|
"1
this represents a slow heart rate ( <100 beats/ min)" |
|
|
When the newborn coughs with the introduction of a catheter in the nostril, what is the rating in the Apgar?
|
2
|
|
|
When are the newborn's Apgar scores calculated?
|
At 1 and 5 minutes
|
|
|
What is the average chest circumference for a newborn?
|
30 to 36 cm
|
|
|
How does the chest circumference compare to the head circumference?
|
The chest circumference is usually 2 to 3 cm smaller
|
|
|
What is the expected respiratory rate for newborns?
|
40-60 respirations
|
|
|
How would the respiratory rate of a baby delivered vaginally compare to a Cesarean section baby?
|
The C/S baby would have a faster respiratory rate than the vaginally delivered baby
|
|
|
Should we expect a baby to breathe through their nose or mouth?
|
"Through the nose.
They are obligate nose breathers" |
|
|
What is a common breathing pattern for newborns?
|
"Periodic breathing
This is a sequence of relatively vigorous respiratory efforts followed by apnea of as long as 10 to 15 seconds" |
|
|
What changes to the periodic breathing should cause concern in a newborn?
|
You should be concerned if the apneic episodes are prolonged and the baby tends to become centrally cyanotic
|
|
|
How long should we expect periodic breathing in a full term newborn?
|
In the term infant, periodic breathing should wane a few hours after birth
|
|
|
A preterm infant is ______ likely to have periodic breathing.
|
"more.
The more premature an infant at birth, the more likely some irregularity in the respiratory pattern will be present" |
|
|
Upon physical exam of a newborn , you notice repeated sneezing, what pathology should you consider?
|
"None
Sneezing is frequent and expected- it clears the nose" |
|
|
A nurse asks you to check an infant with frequent, irregular bouts of hiccuping, should you consider this alarming?
|
"Yes
Although silent frequent hiccups are expected after meals; overall frequent hiccups can suggest seizures, encephalopathy, drug withdrawals." |
|
|
Upon observation, you notice that the newborn's abdomen distends on inspiration while the chest wall collapses, how do you document this type of breathing?
|
"Paradoxical breathing.
It is common for newborns to use their abdominal muscles as well as their diaphragm" |
|
|
Coughing is _____ in a newborn.
|
"rare
Coughing should be considered a problem." |
|
|
Newborns rely primarily on ____ for their respiratory effort.
|
Diaphragm
|
|
|
What are some possible causes for asymmetric chest expansion in a newborn?
|
"pneumothorax
atelectasis diaphragmatic hernia" |
|
|
A fractured clavicle could be expected with a _______ delivery.
|
difficult forceps
|
|
|
Why are adventitious breath sounds suspected after delivery?
|
Crackles and rales are commonly heard immediately after birth because fetal fluid has not been completely cleared
|
|
|
Stridor is a high-pitched, piercing sound heard most often, during which phase of respiration?
|
Inspiration
|
|
|
What is respiratory grunting?
|
it is a mechanism where the infant tries to expel trapped air or fetal lung fluid while trying to retain air and increase oxygen levels
|
|
|
In the presence of stridor, hoarseness, coughing and retractions of the chest wall; where can the potential obstruction be localized?
|
"High in the respiratory tree.
It signifies a problem in the larynx or in the trachea" |
|
|
Name some signs of respiratory distress in an infant.
|
"Inspiration much longer expiration ( I:E ratio of 3:1 or 4:1)
respiratory grunting Retraction at the supraclavicular notch and contraction of the sternocleidomastoid muscles Stridor" Nasal flaring |
|
|
How does the respiratory rate of a newborn compare to a 3 year old?
|
A newborn has respirations of 30 to 80 where a three year old has respirations of 20 to 30
|
|
|
When should we start to look for intercostal muscle use in a child ?
|
By the age of 6 or 7
|
|
|
When should we expect a respiratory rate of 12 to 20 per minute?
|
by the age of 17
|
|
|
A 3 year old is brought to the ER by his mother who hears wheezing for the first time. Other than asthma, what should you suspect?
|
Foreign body
|
|
|
Bronchiolitis is _____ airway disease vs. Bronchitis is _____ airway disease.
|
"small
large" |
|
|
What is the usual causative agent for bronchiolitis?
|
Respiratory syncytial virus
|
|
|
What age group is most affected by bronchiolitis?
|
infants younger than 6 months
|
|
|
What is the expected breathing pattern in an infant with bronchiolitis?
|
"Difficult expirations with rapid and short breaths.
Generalized retractions and perioral cyanosis can develop" |
|
|
What is tracheomalacia?
|
A lack of rigidity or a floppiness of the trachea or airway.
|
|
|
What is the treatment for tracheomalacia?
|
"None.
This tends to be benign and self-limited with increasing age." |
|
|
What is the most common age range for croup?
|
1 1/2 to 3 years
|
|
|
What is the common age range for epiglottis?
|
It most often occurs in children between the ages 3 and 7
|
|
|
What are the key differences between croup and epiglottitis?
|
"Epiglottitis-NO COUGH
unable to swallow, has drooling from an open mouth HIGH FEVER child sits straight up with neck extended and head held forward Croup-HARSH, BARKLIKE COUGH NO FEVER labored breathing, retraction, hoarsness, and inspiratory stridor" |
|
|
Where is the inflammatory process located in croup?
|
Subglottic and may involve areas below the larynx.
|
|
|
What are involved organ systems with cystic fibrosis?
|
"Lung
Pancreas Sweat glands" |
|
|
What GI abnormalities are associated with cystic fibrosis?
|
"malabsorption
poor weight gain intestinal obstruction" |
|
|
How do many states screen for cystic fibrosis?
|
They check for mutations of CTFR ( cystic fibrosis transmembrane conductance regulator)
|
|
|
What pathological lung changes can we expect with cystic fibrosis?
|
"Bronchiectasis with cyst formation
Thick mucus causing progressive clogging of the bronchi and bronchioles" |
|
|
What is the most common location for a diaphragmatic hernia?
|
On the left side (90%)
|
|
|
What is the typical presentation of an infant with diaphragmatic hernia?
|
Bowel sounds heard in the chest with a flat or scaphoid abdomen with a usually displaced heart to the right
|
|
|
When is respiratory distress syndrome most common?
|
most frequently seen with decreasing gestational age, maternal diabetes and acute asphyxia
|
|
|
What is the underlying cause for RDS?
|
Surfactant deficiency
|
|
|
Tachypnea, retractions, grunting and cyanosis in a preterm infant should cause you to consider _____
|
respiratory distress syndrome
|
|
|
Tracheomalacia is associated with _____ stridor.
|
inspiratory
|
|
|
What is responsible for pumping blood into the systemic circulation of the fetus?
|
Both the right and left ventricle
|
|
|
How does the right ventricle bypass the lungs to get blood to the systemic circulation in the fetus?
|
The RV pumps blood through the PDA rather than through the lungs
|
|
|
How long does it take for the patent ductus arteriosus to normally close?
|
Within 24 to 48 hours
|
|
|
When should we expect to see the relative sizes of the left and the right ventricle approach that of an adult?
|
by age 1
|
|
|
What is the normal ratio of the left and right ventricle in an adult?
|
2:01
|
|
|
How would we locate the apex of the heart in a child using the surface anatomy?
|
4th intercostal space
|
|
|
What is the position of the heart in a child?
|
It is usually more horizontal in a child
|
|
|
When should we expect to see the positioning of the heart to approximate an adult?
|
By the age of 7 years
|
|
|
What disease does a Still murmur indicate?
|
"none
an innocent murmur" |
|
|
What is the cause of a Still murmur?
|
It is the result of vigorous myocardial contraction, the resulting stronger blood flow in early systole or midsystole, and the rush of blood from the larger chamber of the heart into the smaller bore of a blood vessel
|
|
|
You are conducting a high school sports physical and you hear a grade II midsystolic murmur with a split S2 that disappears when the patient sits up. What do you suspect?
|
An innocent (Still) murmur
|
|
|
Examine the heart of a newborn once at _____ and again at ______.
|
"within the first 24 hours
2-3 days later" |
|
|
What cardiac abnormalities should you suspect with severe cyanosis immediately after birth?
|
Transposition of the great vessels, tetralogy of Fallot, tricuspid atresia, a severe septal defect, or severe pulmonic stenosis
|
|
|
Which other organ systems need to be considered when examining the heart of a new born
|
"skin
lungs liver" |
|
|
What is more commonly the presenting physical finding in a newborn with right-sided congestive heart failure?
|
large firm livers
|
|
|
A newborn with purplish skin should immediately suggest _______ to you.
|
polycythemia
|
|
|
A mother of a newborn calls your office with complaints that her child's fingers and toes are bluish. How should you counsel her?
|
Reassure, it usually disappears within a few days or even a few hours after birth
|
|
|
A mother of a newborn calls your office with complaints that her child's face is bluish. How should you counsel her?
|
Have her go to the ER, this can suggest CHF
|
|
|
Where should you feel the Apical impulse of a newborn?
|
It is felt at the fourth and fifth left intercostal space just medial to the midclavicular line
|
|
|
Where should you expect the apical impulse to be in a left sided pneumothorax ?
|
It would be deviated away, in the right ward direction
|
|
|
What clinical condition should you expect if you are able to palpate the closure of the pulmonary valve in the second left intercostal space in a newborn?
|
"None.The right ventricle is relatively more vigorous than the left"
|
|
|
Which heart sound is more discrete in a newborn?
|
S2 in infants is higher in pitch and more discrete than S1
|
|
|
When you reexamine a newborn for the second time, two days later, you notice a new split S2. What should be concerned about?
|
"Nothing.Splitting of the heart sounds is common. S2 is usually heard with a split at birth, then often splits within a few hours"
|
|
|
Why are murmurs common in newborns?
|
Most murmurs are innocent and are the result of the transition from fetal to pulmonic circulation.
|
|
|
What are some common characteristics of innocent newborn murmurs?
|
Systolic, Grade I to II, unaccompanied by other signs and symptoms
|
|
|
What maneuvers can help you distinguish a right to left shunt from a left to right shunt in a newborn?
|
"Push up on the liver to increase the right atrial pressure.
This should intensify a right to left shunt but it should cause the left to right shunt or PDA to disappear" |
|
|
What are some characteristics of a murmur in a newborn that should cause concern?
|
"1. If heard continuously after a few days of life
2. Has a diastolic component 3. has a radiations 4. Fills Systole 5. Is intense" |
|
|
What is a characteristics of a patent ductus arteriosus murmur?
|
continuous, machinery- like
|
|
|
What has more diagnostic significance in a newborn, diastolic or systolic murmurs?
|
Diastolic murmurs are always significant
|
|
|
What should be the differential diagnosis in a baby with a diastolic murmur?
|
"Early closing ductus arteriosus or pulmonary insufficiency"
|
|
|
What concerns should you have in an infant whose heart rate drops from 180 to 120 when sleeping?
|
"none. Infant's heart rates are more variable than that of older children.The variation is greatest at or shortly after birth"
|
|
|
What are the expected changes in a child with longstanding cardiomegaly?
|
A bulging precordium, because a child's thoracic cage tends to be more cartilaginous and yielding than that of an adult
|
|
|
What is the the expected rate of a 6 year old?
|
75 to 115
|
|
|
What are the common ages for Still murmurs?
|
age 3 to 7
|
|
|
A still murmur should ____ with activity and ______ with when the child is quiet.
|
"increase
decrease" |
|
|
What maneuvers can increase the intensity of a Still murmur?
|
Activity
|
|
|
What manuevers can decrease the intensity of a Still mumur?
|
rest
|
|
|
What is the expected heart rate in a new born?
|
120-170
|
|
|
With fever in a child, how much should you expect the heart rate to increase with each degree of elevation?
|
10-20 beats increase for each degree of temperature elevation
|
|
|
Describe the heart rate in a child with sinus arrhythmia?
|
The heart rate varies in a cyclic pattern, usually faster on inspiration and slower on expiration
|
|
|
What is the expected heart rate in a 3 year old?
|
80-120
|
|
|
What are the four abnormalities in the Tetralogy of Fallot
|
"Overriding aortic valve
VSD Stenotic pulmonary valve RVH |
|
|
Describe a tet spell
|
Paroxysmal dyspnea with loss of consciousness and central cyanosis
|
|
|
Describe the murmur associated with Tetralogy of Fallot.
|
"Systolic ejection murmur over the 3rd intercostal space, sometimes radiating to the left side of the neck
A single S2 is heard" |
|
|
What is the percentage of VSDs that will close on their own within two years?
|
30 -50 % of small defects will close spontaneously during the first 2 years of life
|
|
|
A small child is examined in your office, and you hear a loud holosystolic murmur along the left sternal border in the 3rd to 5th ICS but there is no JVD and no precordial thrill. What is your diagnosis?
|
"A large VSD.The arterial pulse is small and jugular venous pulse is unaffected. A smaller defect causes a louder murmur and a more easily felt thrill"
|
|
|
Describe eythema marginatum
|
It is a flat or slightly raised rash with pink margins with pale centers and a ragged edge
|
|
|
What is the typical murmurs of acute rheumatic fever?
|
"Mitral Regurgitation
Aortic Insufficiency" |
|
|
Which is more likely to cause CHF in a child, a large ASD or a large VSD
|
A large VSD, heart failure rarely occurs in children with ASD
|
|
|
What maneuvers can differentiate a murmur caused by patent ductus arteriosus and murmur of venous hum?
|
A murmur caused by PDA is unaltered by a postural change unlike venous hum
|
|
|
You hear a continuous machinery like murmur at the first to third ICSs and the lower sternal border in a newborn. What should you suspect?
|
Patent ductus arteriosus
|
|
|
In a child with PDA, what would you predict as the pulse pressure?
|
Widened
|
|
|
In cardiac tamponade, which side of the heart has restriction in filling? The left or the right?
|
The right
|
|
|
You hear a loud diamond shaped systolic ejection murmur that is heard over the pulmonic area in a 3 year old. What would you expect would happen to the S2?
|
It would be widely split. This is a murmur of atrial septal defect.
|
|
|
What is a common spot for radiation in a significant loud diamond shaped systolic ejection murmur that is heard over the pulmonic area?
|
This is a murmur caused by ASD, it can radiate to the back
|
|
|
What is the normal sequlea for a valve that is affected by ARF?
|
It becomes regurgitant and stenotic
|
|
|
What valves are most commonly affected in ARF?
|
Aortic and mitral
|
|
|
Describe the Jones Criteria for diagnosing ARF.
|
the presence of two major or one major and two minor manifestations suggest a high probability of ARF, if supported by evidence of a preceding group A streptococcal infection
|
|
|
Name all of the minor criteria for the diagnosis of ARF
|
"Previous RF or rheumatic heart disease
Fever Arthralgia Elevated ESR leukocytosis C-reactive protein prolonged PR interval on EKG" |
|
|
You see a patient in the office with arthralgias, fever, with a prolonged PR interval on EKG. You perform a rapid strept test that is positive. Can you diagnose the patient with ARF?
|
"NO. you need two major manifestations or one major and two minor manifestations"
|
|
|
What type of arteries are the target in Kawasaki disease?
|
small and medium -sized arteries
|
|
|
How would you expect the appearance of the left ventricle to appear in a patient with known senile cardiac amyloidosis on echo?
|
Small, thickened
|
|
|
You see a three year old child with a history of fever for 6 days, painless pink eye, a polymorphous rash on the trunk and both legs. You suspect Kawasaki disease but what tools would you need to confirm the diagnosis.
|
You need to detect coronary artery disease by two dimensional echo or coronary angiography
|
|
|
Name the five findings that are common in Kawasaki.
|
"Painless bulbar conjunctiva injection without exudate
Changes in extremities including erythema, edema, and desquamation Polymorphous eyythematous rash of the trunk and extremities Changes in the lips and oral cavity including diffuse oral or pharyhgeal erythma; red strawberry tongue Cervical lymphadenopathy usually unilateral" |
|
|
What are the typical findings on the tongue for Kawasaki disease?
|
Strawberry tongue, white coating on the tongue, prominent papillae on the back of the tongue
|
|
|
What age group is typically affected by Kawasaki disease?
|
80% of the time it affects infants and children under 5 years of age
|
|
|
Describe the rash that is associated with acute rheumatic fever.
|
flat or slightly raised, painless rash with pink margins with pale centers and a ragged edge- Erythema marginatum
|
|
|
Where do you auscultate for a venous hum?
|
Ausculate over the supraclavicular space at the medial end of the clavicle and along the anterior border of the SCM
|
|
|
What maneuver will increase the intensity of a venous hum?
|
When the patient is sitting with the head turned away from the area of auscultation
|
|
|
What maneuver will decrease the intensity of a venous hum?
|
It is diminished with the Valsalva maneuver; it can be interrupted by gentle pressure over the vein in the space between the trachea and the SCM at about the level of the thyroid cartilage.
|
|
|
What is the cause of a venous hum?
|
It is caused by the turbulence of blood flow in the IJ veins
|
|
|
Describe venous hum murmur.
|
the hum is a continuous low-pitched sound that is louder during diastole.
|
|
|
What other murmurs can be confused with venous hum?
|
PDA, aortic regurg, aortic stenosis murmur that has been transmitted into the carotid arteries
|
|
|
The absence of femoral pulses in an infant can mean _____.
|
coarctation of the aorta
|
|
|
What are the clues on physical diagnosis of a possible coarctation of the aorta?
|
A difference in pulse amplitude between the UE; a difference in pulse amplitude between the femoral and radial pulses ; absence of femoral pulses
|
|
|
What is the usual newborn BP?
|
Systolic- 60 to 96; diastolic 30-62
|
|
|
What are the possible reasons for hypertension in a newborn?
|
Thrombosis after the use of an umbilical catheter; stenosis of the renal artery; coarctation of the aorta, cystic disease of the kidney, neuroblastoma, Wilms tumor, hydronephrosis, adrenal hyperplasia, or CNS disease.
|
|
|
What is the expected capillary refill in children younger than 2 years old?
|
rapid, less than 1 second
|
|
|
What is the associated capillary refill that indicates shock in child younger than 2 years old?
|
longer than 2 seconds
|
|
|
How does the blood pressure obtained by auscultaion and palpation compare to the BP gotten by flush technique in a young child?
|
flush technique gives a value lower than the systolic BP and higher than the diastolic BP
|
|
|
What is Korotkoff phase that should be used for a diastolic BP in a child?
|
The Korotkoff phase 4- when the sound becomes muffled. In adolescence, use phase 5 - when the sound disappears
|
|
|
Facial palsy in a child should be a clue to _____
|
severe hypertension
|
|
|
If the radial artery is used in place of the brachial artery in obtaining the BP, how should the reading be adjusted?
|
Using the radial artery will give you about 10 mmHg less than that at the brachial artery
|
|
|
What is the prehypertensive range in child?
|
90th to 95th percentile
|
|
|
What is the hypertensive range in child?
|
more than 95th percentile
|
|
|
How should you moniter the BP in a prehypertensive child?
|
It should be taken twice on the same visit and the systolic and diastolic BPs should be averaged.
|
|
|
In a child under the age of 10, hypertension should be considered as ____.
|
secondary
|
|
|
Where is the most commmon location for coarctation of the aorta?
|
It is most commonly seen in the descending aortic arch near the origin of the left subclavian and ligamentum arteriosum
|
|
|
What are some of the vascular complications of Kawasaki disease?
|
Vascular stenosis and aneurysm formation
|
|
|
What is the average period from breast bud to menarche?
|
2 years
|
|
|
When do most girls start menstruation?
|
At Tanner stage 4
|
|
|
What is the average interval from the appearance of the breast bud stage 2 to menarche?
|
2 years
|
|
|
What is the thelarche?
|
Breast development
|
|
|
What is responsible for newborn breast enlargement?
|
The passively transferred maternal estrogen
|
|
|
When does newborn breast enlargment normally resolve?
|
It usually disappears within 2 weeks
|
|
|
What breast changes can be found in males at puberty?
|
they can have transient unilateral or bilateral subareolar masses that will most likely disappear in a year
|
|
|
What should the consistency of the adolescent female breast feel like?
|
homogeneous, dense, firm and elastic
|
|
|
Asymmetry in the right and left breasts of the adolescent female is _____
|
common
|
|
|
What are the other signs of sexual maturation in premature thelarche?
|
these would be absent
|
|
|
What is the cause of premature thelarche?
|
unknown
|
|
|
At which gestational age doe the pancreatic buds, liver and gallbladder begin to form?
|
4 weeks gestation
|
|
|
Motility of the GI tract develops in a ____________ direction.
|
cephalocaudal
|
|
|
At what gestational age does the liver begin to form blood cells? Synthesize glycogen? produce bile?
|
week 6 - form blood cells; week 9 - glycogen; week 12 - bile
|
|
|
When does the GI tract reach adult levels of function in a child?
|
2-3 years; continues to develop elasticity, musculature, and control mechanism
|
|
|
How long does the spleen continue to participate in blood formation?
|
for the first year of life
|
|
|
When does nephrogenesis begin?
|
during the second embryonic month
|
|
|
When are the kidneys first able to produce urine?
|
12 weeks
|
|
|
When does the development of new nephrons cease?
|
36 weeks of gestation. NOTE: after birth, the kidneys enlarge via growth of existing nephrons and adjoining tubules
|
|
|
What are the most helpful symptoms in diagnosing appendicitis in a child?
|
vomiting, rebound tenderness, rectal tenderness, and fever- RLQ tenderness is less helpful
|
|
|
What is the Alvarado score?
|
AKA the MANTRELS: Migration of pain, Anorexia, Nausea/Vomiting, Tenderness in the RLQ, Rebound pain, Elevation of Temp, Leukocytosis, Shift to the left- validated in children and adults.
|
|
|
What does a scaphoid abdomen in an infant suggestive of?
|
that the abdominal contents are displaced into the thorax; **especially when seen with respiratory distress; bowels sounds may be appreciated into chest
|
|
|
The abdominal and chest movements should be ____ in an infant?
|
synchronous
|
|
|
What are the vessels that should be present in the umbilical cord?
|
Two arteries and one vein
|
|
|
What do spider nevi in an infant suggest?
|
liver disease; however, superficial veins are normally seen
|
|
|
What is an omphalocele?
|
any intestinal structure present in the umbilical cord or protruding into the umbilical area and visible through a thick transparent membrane
|
|
|
When does the typical umbilical stump separate from the umbilicus?
|
typically by 2 weeks of age
|
|
|
What does drainage after umbilical cord separation suggest?
|
patent urachal cyst or remnant
|
|
|
Are umbilical hernias an expected finding in newborns?
|
yes; most hernias will close spontaneously by 1-2 years
|
|
|
The presence of perstaltic waves and frequent vomiting in an infant could be caused by ____.
|
an intestinal obstruction, like pyloric stenosis
|
|
|
What conditions does a palpable spleen in a newborn suggest?
|
None; the spleen is usally palpable 1 to 2 cm below the left costal margin during the first few weeks after birth.
|
|
|
When might you see diastasis rectus abdominis?
|
in pregnancy; and in newborns (1-4 cm) = expected findng, no need to repair it
|
|
|
When should Henoch-Schonlein purpura be considered as a cause of acute abdominal pain?
|
from 2- 11 years
|
|
|
How does the umbilical cord give clues to the nutrition of the newborn?
|
a thick umbilical cord suggests a well-nourished infant; a thin cord suggests otherwise
|
|
|
When should intussusception be considered as part of the differential diagnosis in acute abdominal pain?
|
from birth to 5 years old
|
|
|
When should bowel sounds be first present in a newborn?
|
within 1-2 hours of birth
|
|
|
What do renal bruits in newborns suggest?
|
renal artery stenosis (high frequency and soft bruit); and rarely with a renal arteriovenous fistula (continuous bruit)
|
|
|
When should we expect a child to lose the potbellied appearance and take on a convex contour?
|
after 5 years old
|
|
|
Which condition of the mother can cause an enlarged liver in the newborn?
|
gestational diabetes
|
|
|
In infants and toddlers, the liver edge may be palpable ______ below the right costal margin
|
1-3 cm
|
|
|
normal liver span at 6 month old
|
2.4 - 2.8 cm
|
|
|
normal liver span at 12 months
|
2.8 - 3.1 cm
|
|
|
normal liver span at 24 months
|
3.5 - 3.6 cm
|
|
|
normal liver span at 3 years
|
4.0 cm
|
|
|
normal liver span at 4 years
|
4.3 - 4.4 cm
|
|
|
normal liver span at 5 years
|
4.5 - 4.8 cm
|
|
|
normal liver span at 6 years
|
4.8 - 5.1 cm
|
|
|
normal liver span at 8 years
|
5.1 - 5.6 cm
|
|
|
normal liver span at 10 years
|
5.5 - 6.1 cm
|
|
|
More than half of all masses detected in newborns are __________ in origin
|
genitourinary ;hydronephrosis, multicystic dysplastic kidney are the most common
|
|
|
What is the most common cause of bowel obstruction in infants and children 3months to 6 years of age?
|
intussusception
|
|
|
olive-shaped mass found in RUQ of infant immediately after he vomits suggests which condition?
|
pyloric stenosis
|
|
|
sausage-shaped mass in RUQ may indicate which condition in an ill-appearing or lethargic infant or toddler?
|
intussusception
|
|
|
What are the most common types of abdominal tumors in infants and toddlers?
|
neuroblastoma;Lymphoma;Wilms tumor
|
|
|
When is intussusception most commonly seen and what causes it?
|
seen in infants 3-12 months old
|
|
|
What is the cause of intussusception
|
lymph tissue hyperplasia is thought to lead to mucosal prolapse with the most common site being the terminal ileum into the colon; may be caused from Meckel diverticulum, poylp, lymphoma in older children (2 years)
|
|
|
How can intussusuception be diagnosed and treated at the same time?
|
Air contrast enema
|
|
|
What is the Dance sign?
|
Found in intussusception; a sausage- shaped mass that may be palpated in the right and left upper quadrant, but the RLQ feels empty
|
|
|
Intussusception is more common in ____ but pyloric stenosis is more common in _____
|
girls; boys
|
|
|
What is the stool appearance in intussusception?
|
In the early stages, it is often normal; as ischemia progresses- the stool becomes mixed with blood and mucus with a red currant jelly appearance
|
|
|
What GI disorder is thought to be caused by erythomycin use in infants?
|
pyloric stenosis
|
|
|
In which disease is meconium ileus often seen?
|
cystic fibrosis
|
|
|
____ enemas can be used to diagnose and treat meconium ileus. _____ enemas can be used to diagnose and treat intussusception.
|
Gastrograffin; air
|
|
|
What are some of the complications from meconium ileus?
|
volvulus, atresia or meconium peritonitis
|
|
|
Meconium ileus is diagnosed after failing to pass meconium for the first ___ hours after birth
|
24
|
|
|
When does biliary atresia typically result in jaundice?
|
in the first two months of life
|
|
|
What is the embryonic remnant that results in Meckel's diverticulum?
|
It develops from incomplete obliteration of the vitelline duct
|
|
|
What is Biliary atresia?
|
congential obstruction or absence of some or all of the bile duct system resulting in bile flow obstruction;most have complete absence of the entire extrahepatic biliary tree.
|
|
|
What is the common presenting finding on meckel diverticulum?
|
painless rectal bleeding
|
|
|
Differentiate between the two different types of biliary atresia and what causes each.
|
postnatal onset (85-90%)-inflammation and necrosis from perinatal insult (i.e. viral infection); embryonic onset- gene mutations controlling bile duct formation and differentiation early in gestation, associated with other anomalies i.e polysplenia syndrome, may also have heart murmurs
|
|
|
What is Meckel diverticulum and what causes it?
|
outpouching of the ileum that varies in size from a small appendiceal process to a segment of bowel several inches long, often in the proximity of the ileocecal valve
|
|
|
What is the most common congenital anomaly of the GI tract?
|
Meckel Diverticulum
|
|
|
What is necrotizing enterocolitis and where in the intestine is usually seen?
|
Inflammatory disease of the GI mucosa associated with prematurity and gut immaturity; most commonly seen in the distal ileum and proximal colon
|
|
|
What is pneumatosis intestinalis and it is seen on radiograph in which condition?
|
air in the bowel wall; seen in necrotizing enterocolitis
|
|
|
Which disease presents as a firm, fixed, nontender, irregular and nodular abdominal mass that crosses the midline?
|
neuroblastoma
|
|
|
Which disease is associated with Horner's syndrome, ataxia, and opsomyoclonus
|
neuroblastoma
|
|
|
What is opsomyoclonus?
|
dancing eyes and dancing feet;seen in neuroblastoma
|
|
|
What is Wilms tumor and which gene mutation causes it?
|
nephroblastoma;usually appears at 2-3 years of age;gene mutation in WT1 (chromosome 11) = regulates normal kidney development
|
|
|
When do symptoms typically present in Hirschsprung disease?
|
At birth with failure to pass meconium in the first 24 to 48 hours after the birth
|
|
|
What is the most common intraabdominal tumor of childhood?
|
Wilms tumor (nephroblastoma)
|
|
|
What is Hirschsprung Disease?
|
primary absence of parasympathetic ganglion cells in a segment of the colon which interrupts intestinal motility
|
|
|
What is the triad of symptoms seen in Hemolytic Uremic Syndrome (HUS)?
|
1) microangiopathic hemolytic anemia 2) thrombocytopenia 3) uremia
|
|
|
Which microorganism causes Hemolytic Uremia Syndrome in children?
|
Shiga-like toxin producing E. Coli O157:H7
|
|
|
In adolescents whose hymen is intact, about how large is the vaginal opening?
|
1 cm
|
|
|
What are a few changes that occur in the vagina during puberty?
|
It lengthens, the epithelial layers thicken and the vaginal secretions become acidic.
|
|
|
On average, when does menstruation begin?
|
Between 11 and 14 in the United States.
|
|
|
How does the vagina change in adolescence?
|
The vagina lengthens, and the epithelial layer thicken and the vaginal secretion become acidic
|
|
|
Just before menarche, vaginal secretions _________.
|
increase
|
|
|
Where is the hymen usually located?
|
The hymen is a thin diaphragm just inside the introitus, usually with a crescent shaped opening in the midline
|
|
|
When does functional maturity of the reproductive organs occur?
|
During puberty.
|
|
|
When examining an infant's external genitalia, which position should the legs be in?
|
Infant's legs are held in frog position.
|
|
|
How do the labia majora look like prior to 36 weeks gestation?
|
Labia majora are widely separated and the clitoris is prominent up to 36 weeks.
|
|
|
How do the labia majora/minora look by full term?
|
Full term, majora completely cover the labia minora and clitoris.
|
|
|
When a newborn girl is born, and the mother sees that the child's labia majora and minora are swollen and the hymen is slightly protruding what would you tell her?
|
That these are transient changes that simply reflect the mother's own hormones and will disappear in a few weeks.
|
|
|
What is the appearance of the clitoris in very premature girls?
|
Remember that all really premature female infants seem to have clitoromegaly. Only one as 5000 babies will have endocrine problems (adrenal hyperplasia).
|
|
|
Average size of central opening of the hymen?
|
.5 cm
|
|
|
An imperforate hymen can lead to what in a child? In adolescents?
|
Child- hydrocolpos; Adolescent- hematocolpos
|
|
|
A baby girl is brought into the physician's office because of white, mucoid vaginal discharge. The mother said it's occasionally mixed with blood. The kid is no older than 4 weeks old.
|
You would tell the parent that this finding is the result of passive hormonal transfer from the mom to the child. It's temporary and an expected finding.
|
|
|
Vaginal discharges in infants and young children that are mucoid in appearance are caused by?
|
Irritation from their diaper or powder.
|
|
|
When examining children, is an external examination adequate enough or do you need to do an internal one too?
|
External is enough. Only perform internal if there is bleeding, discharge, trauma or suspected sexual abuse.
|
|
|
What is anterior labial traction?
|
A technique used to visualize the interior of the vagina and the hymenal opening in prepubertal girls.
|
|
|
Are Bartholin and skene glands palpable in children?
|
No, if they are enlargement exists. It can indicate an infection, which is most often gonococcal.
|
|
|
If a girl has an imperforate hymen and you ask her to cough, what would you expect?
|
The imperforate hymen will bugle. A hymen with an opening will not.
|
|
|
Causes of genital bleeding in children:
|
1. genital lesions 2. vaginitis 3. foreign body 4. trauma 5. tumors 6. endocrine changes 7. estrogen ingestion 8. precocious puberty 9. hormone-producing ovarian tumor
|
|
|
When performing the rectal examination on a child, what is one method of getting them to relax their muscles?
|
Having the child 'pant like a puppy'.
|
|
|
For women who are not sexually active, when should the first pelvic examination take place?
|
21 years of age
|
|
|
What methods of screening for STDs do adolescents tend to prefer?
|
First-void urine specimens and self-collected vaginal swab specimens. Still, pelvic exams are the best.
|
|
|
How large should the hymenal opening be by the time menarche starts?
|
About 1 cm wide.
|
|
|
What is likely the causative agent of vulvovaginitis after a recent upper respiratory infection or pharyngitis?
|
Group A beta-hemolytic Streptococcus
|
|
|
What symptoms would likely indicate a pinworm associated vulvovaginitis?
|
Vaginal pruritis especially at night
|
|
|
What is hydrocolpos?
|
It is the distention of the vagina caused by accumulation of fluid due to congenital vaginal obstruction
|
|
|
What are the likely causes for hydrocolpos?
|
It is likely caused by obstruction that is usually caused by imperforate hymen or a transverse vaginal septum
|
|
|
What is the expected appearace of hydrocolpos on abdominal ultrasound
|
It will show a large midline translucent mass displacing the bladder forward
|
|
|
What controls the development of the sex organs during fetal development?
|
The presence or absence of male hormones
|
|
|
A _____ of male homones in a genetic male fetus results in ambiguous genitalia
|
deficiency
|
|
|
A _____ of male homones in a genetic female fetus results in ambiguous genitalia
|
presence
|
|
|
What clues in the family history would predispose someone to developing ambiguous gentalia
|
Unexplained deaths in early infancy, Infertility in close relatives, Abnormal development in puberty or a history of known congenital adrenal hyperplasia
|
|
|
What other conditions also commonly occurs with males in the presence of ambiguous genitalia
|
Undescended testicles
|
|
|
What is the appearance of the genitalia in a genetic female in the presence of ambiguous genitalia?
|
There would be an enlarged clitoris that has the appearance of a small penis, the urethral opening would be anywhere alone, above, or below the surface of the clitoris, The labia would be fused resembling the scrotum, and a lump of tissue would be felt within the labia giving the appearance of testicles
|
|
|
What is the appearance of the genitalia in a genetic male in the presence of ambiguous genitalia?
|
There would be a small penis that resembles an enlarged clitoris that has the appearance of a small penis, the urethral opening would be anywhere alone, above, or below the penis or as low as the peritoneum, there would be a small scrotum with any degree of separation resembling labia
|
|
|
When does fetal insult have to occur in order to affect male or female genitalia to have a major impact?
|
during 8 to 9 weeks
|
|
|
If you examine a full term newborn and find the testicles in the inguinal canal, do they need surgery?
|
No, the final descent into the scrotum can occur in the early postnatal period
|
|
|
If you examine a full term newborn and find that the prepuce is not completely separated from the glans, do they need surgery?
|
No, this is usually incomplete at birth and remains so until 3 to 4 years in uncircumcised males
|
|
|
What is the pubic hair pattern at the end of puberty?
|
The pubic hair is curly, dense, and coarse, and forms a diamond shaped pattern from umbilicus to the anus
|
|
|
When does gestation sexual differentiation occur in the fetus?
|
by 12 weeks of gestation
|
|
|
Dx: hooked, downward bowing of penis
|
chordee
|
|
|
What is the appearance of the scrotum in a premature infant vs a full term ?
|
the scrotum of the premature infant may appear underdeveloped, without rugae and a midline raphe. The full term neonate has a loose, pendulous scrotum with rugae and a midline raphe
|
|
|
What is a bifid scrotum?
|
A scrotum with a deep cleft that is usually associated with other GU anomalies or ambiguous genitalia
|
|
|
How can you prevent the cremasteric reflex from causing scrotal retraction in a newborn?
|
Place the thumb and index finger of one hand over the inguinal canals at the upper part of the scrotal sac.
|
|
|
What should the approx size of the testicle in a newborn?
|
1 cm
|
|
|
How should you classify a testicle that is in the inguinal canal but can be pushed into the scrotum?
|
As a descended but retractile testis
|
|
|
How should you classify a testicle that is in the inguinal canal but cannot be pushed into the scrotum?
|
As a undescended testicle
|
|
|
How can you detect an "invisible" hernia in a newborn?
|
Palpate over the internal inguinal canal with the flat part of the fingers. Roll the spermatic cord beneath the fingers to feel the solid structure going through the ring --> if the smooth feeling disappears then the peritoneum is passing through the ring
|
|
|
When assessing a scrotal mass, you note that it reduces when you attempt reduction through the external inguinal canal, what is the mass likely to be?
|
A hernia
|
|
|
When assessing a scrotal mass, you note that it does not reduce but that it also doesn't transilluminate, what is the mass likely to be?
|
An incarcerated hernia
|
|
|
When assessing a scrotal mass, you note that it transilluminates but does not reduce, what is the mass likely to be?
|
hydrocele
|
|
|
What type of hernia is considered a surgical emergency?
|
An incarcerated hernia
|
|
|
What are the risks accompanying a retractile testicle?
|
It could become an ascending or acquired undescended testis --> these require long term exams
|
|
|
Dx: dribbling or reduced force/caliber of urine stream (1)
|
stenosis of urethral meatus
|
|
|
with what chrom abnormalities is hypospadias associated? (2)
|
47XXY, 47XYY
|
|
|
when is edema of newborn scrotum a common finding?
|
after breech delivery
|
|
|
Dx: feeling of smoothness disappears as you palpate spermatic cord over inguinal canal
|
peritoneum passing through the ring
|
|
|
Dx: mass in scrotum that neither changes in size nor tranilluminates
|
incarcerated hernia
|
|
|
Dx: penis is swollen, tender with ecchymotic lesions
|
sexual abuse
|
|
|
what 2 positions help push the testes into the scrotum during exam of young male?
|
tailor position ("indian style"), sit in chair with heels on the chair
|
|
|
What determines sexual maturity in a male adolescent?
|
Changes in pubic hair, development of the testes and scrotum, and penis
|
|
|
Dx: hard, enlarged, painless testicle
|
tumor
|
|
|
Acute scrotal swelling with discoloration could likely be _____ or ____. Acute scrotal swelling without discoloration and a nodular epididymis could be ___
|
torsion of the spermatic cord or orchitis; epididymitis
|
|
|
What are the possible causes of penile enlargement without testicular enlargement?
|
precocious puberty, adrenal hyperplasia, and some CNS lesions
|
|
|
At __weeks of gestation a portion of the caudal hindgut is divided by an anorectal septum into a urogenital sinus and a rectum.
|
7 weeks
|
|
|
The ___ is covered by a membrane that develops into the anal opening by 8 weeks of gestation
|
urogenital sinus
|
|
|
Most anorectal malformations result from abnormalities in this partitioning process.
|
urogenital sinus
|
|
|
The first meconium stool is ordinarily passed within the ____ after birth and indicates anal patency.
|
first 24 to 48 hours
|
|
|
In infants, Both the internal and external sphincters are under involuntary reflexive control because ___ of the spinal cord is incomplete.
|
myelination
|
|
|
Control of the external anal sphincter is gradually achieved between the ages of ___ months.
|
18 and 24
|
|
|
The prostate remains undeveloped until ___ at which time androgenic influences prompt its growth and maturation.
|
puberty
|
|
|
How does a prostate become functional?
|
The initially minimal glandular component develops active secretory alveoli
|
|
|
In children, Shrunken buttocks suggests a ____
|
chronic debilitating disease
|
|
|
In kids, Asymmetric buttock creases occur with ____.
|
congenital dislocation of the hips
|
|
|
In kids, Perirectal redness and irritation are suggestive of ___, ____, or other irritants of the diaper area.
|
pinworms, Candida
|
|
|
In children,____results from constipation, diarrhea, or sometimes severe coughing or straining
|
Rectal prolapse
|
|
|
Hemorrhoids are rare in children, and their presence suggests a serious underlying problem such as ____
|
portal hypertension
|
|
|
In children, Small flat flaps of skin around the rectum (condylomas) may be ___ in origin
|
syphilitic
|
|
|
In children, Sinuses, tufts of hair, and dimpling in the pilonidal area may indicate____.
|
lower spinal deformities
|
|
|
Lightly touch the anal opening, which should produce anal contraction (described by clinicians as an "anal wink"). Lack of contraction may indicate a _______
|
lower spinal cord lesion.
|
|
|
If there is no evidence of stool in the newborn, suspect___, ____ or ____.
|
rectal atresia, Hirschsprung disease (congenital megacolon), or cystic fibrosis
|
|
|
Sequence and Description of Stools in Infants: Greenish-black, viscous, contains occult blood; first stool is sterile
|
Newborn meconium
|
|
|
Sequence and Description of Stools in Infants: Transitional: thin, slimy, brown to green
|
3 to 6 days old
|
|
|
Sequence and Description of Stools in Infants: Mushy, loose, golden yellow; frequency varies from after each feeding to every few days; nonirritating to skin
|
Breast-fed
|
|
|
Sequence and Description of Stools in Infants: Light yellow, characteristic odor, irritating to skin
|
Formula-fed
|
|
|
In children, The presence of bruises around the anus, scars, anal tears (especially those that extend into the surrounding perianal skin), and anal dilation may be evidence of ____.
|
sexual abuse
|
|
|
In children, A lax sphincter is associated with lesions of the peripheral spinal nerves or spinal cord, ___ infection, and previous fecal impactions
|
Shigella
|
|
|
Chronic constipation in children with mental deficiency or emotional problems is often associated with a ____
|
rectum distended with feces
|
|
|
What is the position for rectal examination in infants and young children?
|
Have the child lying on his or her back, hold the feet together and flex the knees and hips on the abdomen
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What is an immediate complication of an infant rectal exam?
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Some bleeding and transient prolapse of the rectum
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How can patency of the anus be determined in an infant without meconium stool?
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Inserting a lubricated catheter no more than 1 cm into the rectum
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A consistently empty rectum in the presence of constipation is a clue to the diagnosis of ____
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Hirschsprung disease.
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A fecal mass in the rectum accompanying diarrhea suggests ____
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overflow diarrhea
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A palpable prostate in preadolescent boys suggests ___ or ___ disease, which should be apparent from examination of the genitalia.
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precocious puberty or some virilizing
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How is a potential diagnosis made for enterobiasis?
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Can be diagnosed using Scotch tape test: press the sticky side of cellulose tape agains the perianal folds and press the tape on a glass slide
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Why is nighttime the ideal time for specimen collection in Enterobiasis?
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The adult nematode (parasite) lives in the rectum or colon and emerges onto perianal skin to lay eggs while the child sleeps.
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How does an enterobiasis infection affect the anal area?
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The patient experiences intense itching of the perianal area, and perianal irritation often results from scratching.
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The parents of a six year old girl come in describing unexplained irritability child, especially at night.What should we immediately suspect?
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ENTEROBIASIS (ROUNDWORM, PINWORM)
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The rectum may end blindly, be stenosed, or have a fistulous connection to the perineum, urinary tract, or, in females, the vagina. The condition is usually diagnosed by rectal examination and confirmed by lack of passage of stool within the first 48 hours of life
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IMPERFORATE ANUS
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How do long bones increase in diameter during childhood development?
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By the apposition of new bone tissue around the bone shaft
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How do long bones increase in length during childhood development?
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The proliferation of cartilage at the growth plates.
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Why do children have more fractures than sprains?
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Ligaments are stronger than bone until adolescence
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What Tanner stage is associated with decreased strength in the epiphyses?
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Tanner stage 3
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by what age is bone growth complete?
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20 yo
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at what age is peak bone mass achieved?
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35 yo
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Dx: mass near the spine that transilluminates
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meningocele or myelomingocele
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At what age should child be able to lift head and trunk from prone position?
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2 mo
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The ability of an infant to be able to lift the head and trunk from the prone position, indicates ______
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forearm strength
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What are the spinal curvature changes in an infant who cannot sit without support?
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Kyphosis of the thoracic and lumbar spine in the sitting position
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What lower extremity abnormalities are common in newborns due to positioning?
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Slight varus curvature of the tibias (tibial torsion) or forefoot adduction (metatarsus adductus)
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What foot abnormality is common in all newborns?
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flat footed
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Unequal limb length and circumference are associated with what?
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intraabdominal neoplasms
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Def: Allis sign
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used to detect hip dislocation or a shortened femur. baby supine, knees flexed with feet flat on floor, observe height of knees. When one knee appears lower than the other- positive sign
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By what age should tibial torsion resolve?
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6 mo
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What defect is commonly seen in kids who sit in W or reverse tailor position?
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intoeing and femoral anteversion
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A single palmar crease is associated with _____.
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Down syndrome
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When should you use the Barlow-Ortolani manuever to examine an infant?
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Each time you examine the infant during the first year of life.
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How do you perform the Barlow portion of the Barlow- Ortolani manuever?
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1. flex the hip and knee to 90 degrees ( have your thumb on the inside of the thigh and your fingers gripping the outer thigh with fingertips resting on the greater trochanter) - then adduct the thigh and gently apply downward pressure on the femur in an attempt to disengage the femoral head from the acetabulum. A positive sign is when a clunk or sensation is felt as the femoral head exits the acetabulum posteriorly.
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How do you perform the Ortalani portion of the Barlow- Ortolani manuever?
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`1. Slowly abduct the thigh while maintaining axial pressure 2. With the fingertips on the greater trochanter, exert a lever movement in the opposite direction so that you fingertips press the head of the femur back toward the acetabulum center. If the head of the femur slips back into the acetabulum with a palpable chunk when pressure is exerted, suspect hip subluxation or dislocation.
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What is the most reliable sign of hip subluxation or dislocation by three months of age?
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Muscles and ligaments tighten, limited abduction of the hips
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How do you evaluate for adequate shoulder strength?
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By holding the infant upright with your hands under the axillae. If the infant maintains the upright position then there is adequate shoulder muscle strength but if the infant slips through your fingers then there is muscle weakness
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The feet of the toddler will pronate slightly ___ until about ___.
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inward; 30 months
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How do you evaluate for tibial torsion?
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Child is prone with one knee flexed 90 degrees and align the midline of the foot parallel to the femur. With one hand place the thumb and index finger on the lateral and medial malleoli and the other on the same side of the leg. If your thumbs are not parallel then tibial torsion is present.
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What obscures the longitudinal arch of child until 3 yo?
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fat pad
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Genu varum is a common finding in toddlers until what age?
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up to 18 mo
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Genu valgum is a common finding in toddlers until what age?
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2-4 yo
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Bowleg is also known as _____
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genu varum
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How do you evaluate a child for genu varum?
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Measure the distance between the knees when the medial malleoli of the ankles are together. There is genu varum if there is a space of 2.5 cm between the knees
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You expect a ___ from the normal angle of 10 to 15 degree angle at the tibiofemoral articulation with both genu valgum or genu varum.
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increase
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Knock-knee is also known as _____
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genu valgum
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How do you evaluate a child for genu valgum?
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Measure the distance between the medial malleoli when the knees are together. There is genu varum if there is a space of 2.5 cm between the medial malleoli
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What is the Gower sign?
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indicated Generalized muscle weakness; the child rises from a sitting position by placing hands on the legs and pushing the trunk up
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What are the typical spinal changes in an adolescent?
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May have slight kyphosis and rounded shoulders with an interscapular space of 5 to 6 inches.
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In an adolescent, the shoulders and scapulae should be level with each other within ___ inch and a distance between the scapulae of ______
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1/2; 3 to 5 inches
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What is the most common combo in clubfoot?
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Inversion of the foot at the ankle and plantar flexion, with the toes lower than the heel
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A newborn with medial adduction of the toes and forefoot results from _____.
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angulation of tarsometatarsal joint
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what is the common age range for osgood-schlatter?
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boys between 9 and 15 years of age
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What is the common age range for legg-calve-perthes disease?
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3 to 11 years
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another term for clubfoot
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talipes equinovarus
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Def: angulation of tarsometatarsal joint
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metatarsus adductus (varus); lateral border of foot is convex; resolves after 6 mo
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Dx: avascular necrosis of femoral head, painful limp, loss of IR and abduction, decreased ROM
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legg-calve-perthes disease
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Def: Osgood-Schlatter disease
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traction apophysitis (inflam of bony outgrowth) of anterior aspect of tibial tubercle
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Dx: limp, knee pain, swelling, aggrevated by strenuous activity
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Osgood-Schlatter disease
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Dx: knee pain, antalgic limp, leg weakness, reduced IR of hip, obese child between 8 and 16 yo
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slipped capital femoral epiphysis
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Dx: progressive symmetric weakness and muscle atrophy or pseudohypertrophy; difficulty climbing stairs, waddling gait
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muscular dystrophy
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What structure is torn with radial head subluxation?
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annular ligament
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Dupuytren contracture is seen frequently in pts with what 3 diseases?
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DM, alcoholic liver disease, epilepsy
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What is the common age range for slipped capital femoral epiphysis?
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between 8 to 16 y/o, but girls can be affected earlier
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Inflammation of the anterior patellar tendon is associated with ____
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Osgood-Schlatter disease
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Who are at high risk for Osgood Schlatter disease?
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Obese or overweight children
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What are the early signs of muscular dystrophy?
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clumsiness, difficulty climbing stairs, frequent falls
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What are the spinal changes in scoliosis?
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A concave curvature of the anterior vertebral bodies, convex posterior curves, and lateral rotation of the thoracic spine
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what age group is primarily affected nursemaid's elbow?
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age one to four
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What is the favored position in a child with nursemaid's elbow?
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The child holds arm slightly flexed and pronated; supination is resisted
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What is the mechanism of injury in radial head subluxation?
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jerking the arm upward while the elbow is extended
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What is the critical time period for initial myelination and brain development.
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The first year of life.
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What are primitive reflexes that are present in the newborn
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yawn, sneeze, hiccup, blink at bright light and loud sound, pupillary constriction with light, and withdrawal from painful stimuli.
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Brain growth continues until ___ of age
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12 to 15 years
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Motor maturation proceeds in a ___ direction
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cephalocaudal
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touch one corner of the infant's mouth; the infant should open its mouth and turn its head in the direction of stimulation; if the infant has been recently fed, minimal or no response is expected
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CN V Rooting reflex
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place your finger in the infant's mouth, feeling the sucking action; the tongue should push up against your finger with good strength; note the pressure, strength, and pattern of sucking
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Sucking reflex CN V
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loudly clap your hands about 30 cm from the infant's head; avoid producing an air current; note the blink in response to the sound; no response after 2 to 3 days of age may indicate hearing problems; infant will habituate to repeated testing
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Acoustic blink reflex CN VIII
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hold the infant under the axilla in an upright position, head held steady, facing you; rotate the infant first in one direction and then in the other; the infant's eyes should turn in the direction of rotation and then the opposite direction when rotation stops; if the eyes do not move in the expected direction, suspect a vestibular problem or eye muscle paralysis.
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Doll's eye maneuver CN VIII
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Purposeful movement (e.g., reaching and grasping for objects) begins at about ___ of age
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2 months
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When do we expect the infant to grab an object with one hand?
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6 months
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When do we expect the infant to transfer an object from one hand to the other?
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7 months
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When assessing the patellar reflex in a 6 month old, you see about two beats of clonus. Should you be concerned?
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no, this is a common finding. Infant with clonus over ten beats should be evaluated further
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Hands are usually held in fists for the___ of life, but not constantly
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first 3 months
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The patellar tendon reflexes are present at ___
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birth
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Achilles and brachioradial tendon reflexes appear at ___ of age.
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6 months
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Making sure the infant's head is in midline, touch the palm of the infant's hand from the ulnar side (opposite the thumb); note the strong grasp of your finger; sucking facilitates the grasp; it should be strongest between 1 and 2 months of age and disappear by 3 months
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Palmar grasp (birth) Reflex
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Touch the plantar surface of the infant's feet at the base of the toes; the toes should curl downward; the reflex should be strong up to 8 months of age
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Plantar grasp (birth) Reflex
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With the infant supported in semisitting position, allow the head and trunk to drop back to a 30-degree angle; observe symmetric abduction and extension of the arms; fingers fan out and thumb and index finger form a C; the arms then adduct in an embracing motion followed by relaxed flexion; the legs may follow a similar pattern of response; the reflex diminishes in strength by 3 to 4 months and disappears by 6 months
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Moro (birth) Reflex
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Hold the infant upright under the arms next to a table or chair; touch the dorsal side of the foot to the table or chair edge; observe flexion of the hips and knees and lifting of the foot as if stepping up on the table; age of disappearance varies
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Placing (4 days of age) Reflex
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Hold the infant upright under the arms and allow the soles of the feet to touch the surface of the table; observe for alternate flexion and extension of the legs, simulating walking; it disappears before voluntary walking
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Stepping (between birth and 8 weeks) Reflex
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With your index finger, briskly tap the bridge of the infant's nose between the eyes (glabella) when its eyes are open; observe the sudden symmetric blinking of the eyes; the infant will blink for the first four to five taps.
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Glabella (birth) Reflex
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Suspend the infant in prone position on one of your hands or on a flat surface; stroke one side of the infant's back between the shoulders to the buttocks, about 4 to 5 cm from the spinal cord; observe for the curvature of the trunk toward the side stroked; repeat on the other side.
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Galant or trunk incurvature (birth to 4 weeks) Reflex
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Suspend the infant in prone position on both of your hands so that the infant's legs and arms are extending over both sides of your hand; observe the infant's ability to lift its head and extend its spine on a horizontal plane; the reflex diminishes by 18 months of age and disappears by 3 years.
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Landau (birth to 6 months) Reflex
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Hold the infant suspended in prone position and slowly lower it head first toward a surface; observe the infant extend its arms and legs as if to protect itself; this reflex should not disappear.
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Parachute (4 to 6 months) Reflex
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With the infant supine, turn its head to the side; observe the infant turning its whole body in the direction the head is turned.
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Neck righting (3 months, after tonic neck disappears) Reflex
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Cerebral palsy occurs in an estimated ___ per 1000 births.
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2 to 3
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____ is a group of brain damage syndromes in which a static and nonprogressive cerebral lesion causes significant motor delay and abnormal neuromuscular findings.
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Cerebral palsy
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What is the most common cause of cerebral palsy?
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Injury to the immature periventricular white matter in fetuses and premature infants
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What is the clinical presentation of spastic CP
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Hypertonicity, tremors, scissor gait, toe walking. There are persistent primitive reflexes, exaggerated DTRs
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What is the clinical presentation of dyskinetic CP
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Involuntary slow writhing movements of the extremities; tremors may be present. Exaggerated posturing, inconsistent muscle tone that varies during the day.
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What is the clinical presentation of ataxic CP
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Abnormalities of movement involving balance and position of trunk and extremities. There are intention tremors; also instability and wide based gait
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What maternal health conditions are associated with myelomeningocele?
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Diabetes mellitus, folic acid deficiency, and maternal obesity
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What are the contents of a myelomeningocele?
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The exposed meningeal sac is filled with fluid and nerves
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What are the sensory deficits associated with myelomeningocele?
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May have loss of bladder or bowel control; sensory deficit and paralysis (or weakness) that is dependent on the level of weakness
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Characteristic signs include retinal hemorrhages, altered consciousness with axonal injury, as well as subdural or subarachnoid hemorrhage.
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Shaken baby syndrome
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What is the least reliable observation of the APGAR score?
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color; most new babies have blue fingers and toes
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What issues does the APGAR score not address
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INCREASED irritability, tachypnea, or tachycardia
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What observations about a newborn could you expect to make at 36 weeks?
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Only one or two transverse creases are present on the sole of the foot; the breast nodule is less than 3 mm in diameter; no cartilage is present in the helix of the ear; the testes are seldom in the scrotum that has few or no rugae
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What observations about a newborn could you expect to make at 40 weeks?
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Many creases are present on the sole; the breast nodule exceeds 4mm; cartilage is present in the helix of the ear; and the testes have descended into the scrotum, which is covered with rugae. They will also have predominantly flexed extremities
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A premature infant often has brief periods of apnea lasting up to _____
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20 seconds
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What are the signs of respiratory distress in an infant?
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sustained increased rate, grunting, retraction or intercostal and subcostal spaces and suprasternal notch, seesaw sinking of the chest with rising abdomen and flaring of the nostrils
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What are some medications that put the newborn at risk for neonatal withdrawal syndrome?
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sedatives and anticonvulsants
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What portion of the respiratory exam can you omit in a newborn?
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Chest percussion- little value due to the small chest.
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