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41 Cards in this Set
- Front
- Back
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a simple and repeatable method to quickly and summarily assess the health of newborn children immediately after childbirth
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APGARS score
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a more simplified maturity rating scale for estimating newborn gestational age. It consists of six evaluation areas for neuromuscular maturity and seven items of observed physical maturity. It is the scale probably most often used in the nursery.
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Ballard Scale
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A fine downy hair covering the body of the fetus from 20-28 weeks
At 26 weeks, it begins to disappear around the face and anterior trunk At term, a few patches may be present on the shoulders |
lanugo
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Eyes: assess for red reflex bilaterally – ensure no congenital cataract or intraorbital mass **
Fontanelle: anterior and posterior Ears: pits or tags (can indicate ____________) |
renal anomalies
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Eye Discharge **
Ophthalmia neonatorum in the newborn period is 1.6-12% (tear duct massage, warm compress) N. gonorrhea C. trachomatis What is used to treat gonorrhea? What is used to treat chlamydia? |
gonorrhea: silver nitrate
chlamydia: erythromicin |
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• Successful transition into respiration should occur within _______ of life
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one minute
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• During delivery peripheral nerve damage can occur. The most commonly injured are the ____ and _________ nerves.
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brachial and facial
Unilateral facial nerve palsy is the most common, occuring in approximately 1.4:1000 births? |
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Which newborn rash is the result of keratin deposits in dermis causing small retention cysts typically located over the nose, cheeks, chin and/or forehead?
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Milia
resolves in 3-4wks and no tx is necessary |
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discrete 2-3mm pearly white or yellow, freely mobile, elevations at gum margins or midline in hard palate, and seen in 85% of newborns
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Bohn's Nodules or Epstein's Pearls
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a neonatal rash that typically occurs in the first 3-4 d of life, is self limiting and shows eosinophils on histologic examination.
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Erythema toxicum
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• Q: During morning rounds in the newborn nursery you examine a healthy infant who has blotchy erythematous macules that are 2-3 cm in diameter. Macules are scattered over the face, trunk and proximal extremities. The palms and soles are spared. Ea. Macule has a 1-3 mm central vesicle or pustule. Most likely additional finding is:
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erythema toxicum
o Wright stain of smear contents revealing predom. Eo’s |
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• Q: You are examining a newborn who is the product of an uneventful pregnancy, labor and delivery. Apgars were 9 at both 1 and 5 min. Findings on initial PE were unremarkable except for the presence of vesicopustules and freckle like macules, some of which have collerette of surrounding scale. Wright stain of smear of vesicopustular material reevlas predominance of PMN neutrophils. Most likely diagnosis?
Benign, self limiting Superficial vesiculopustular lesions Easily rupture Evolve into hyperpigmented macules More common in Af. American Neutrophils Present at birth Resolves in 24-48 hrs |
transient neonatal pustular melanosis
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yeast diaper rash often occurs with teething
Between gonorrhea and chlamydia, which one occurs early and which one occurs late |
gonorrhea is early
chlamydia occurs late |
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• On growth charts, healthy children usually fall on a % and grow parallel to it (within ____ curves)
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• On growth charts, healthy children usually fall on a % and grow parallel to it (within 1-2 curves)
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• Q: Typically healthy children usually fall on a %ile and grow parallel to it within 1-2 curves over time. However crossing percentiles can be normal and does occur when a child:
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in his/her first year of life
and during adolescence (growth spurt) |
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Vision screen ***
-Grossly assess vision at each visit -Begin eye chart screening at 3 years What chart is preferred? When should dental sceening be started? |
tumbling E eye chart is preferred
one year |
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-Sinus arrhythmia (benign) prominent at these age
-Careful check for murmurs and femoral pulses ** ***Pathologic murmur occur in diastole continuous murmur ***Innocent murmur best in lower left vibratory/twangy/musical stable through time or they eventually go away may hear again when they are sick occur in systole Q: You are evaluating a healthy 4 yr old girl for her annual health visit. You note clear breath sounds, strong pulses, quiet precordium and a murmur. Your partner noted a murmur at last yr’s appt. Of the following, the finding most consistent with an innocent murmur is: |
Low pitched vibratory systolid murmur at LSB (Still’s)
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These are stages of physical development in children, adolescents and adults. The stages define physical measurements of development based on external primary and secondary sex characteristics, such as the size of the breasts, genitalia, and development of pubic hair.
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Tanner Staging
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GIRLS: Note breasts then hair and then menses
Peak height velocity has occurred prior to menses Typically ___ years from breast buds to onset of menses**** |
Typically 2 years from breast buds to onset of menses****
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• A previously healthy 13 year old girl comes to your office complaining of intermittent cyclic lower abdominal pain for the past 3 months associated with occasional nausea and bloating. She denies sexual activity, vaginal discharge, and dysuria. She has not started menustrating. Her mother and sister both began menustrating at age 13. The best NEXT step in the evaluation of this adolescent girl is:
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Physical examination of the external genitalia (looking for imperforate hymen)
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You are preparing a presentation on teenage pregnancy for the support staff of a local youth agency and plan to review the social, economic and educational problems associated with adolescent parenthood. Of the following, one of the MOST common consequences of teenage parenting is a decreased rate of
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educational achievement
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How long after menarch do most adolescent females develop ovulatory cycles?
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6 months
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• You are the guest speaker at a local high school health class. The subject is reproductive health and a student asks you a question about oral contraceptives. Her grandmother told her that they are especially harmful to a young woman’s health. A TRUE statement regarding adolescents and currently available contraceptive methods is that
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all methods of contraception are associated with fewer health risks than pregnancy and delivery
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condems are not preventative against:
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HPV, herpes, scabies
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• A 15 year old African American girl is brought in to the Emergency Department following the ingestion of 30 500mg acetaminophen tablets. She took the overdose 1 hour following an argument with her boyfriend, who broke up with her. She made a similar attempt about 6 months ago. She has been using marijuana and alcohol for about 2 years ever since her parents separated. Which of the following factors puts her at the GREATEST risk of a completed suicide?
o A. Her previous attempt o B. Her race and gender o C. Use of drugs and alcohol o D. The disruption in her family o E. The method she used What puts her at lowest risk? |
her previous attempt
her race and gender |
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known as the startle reflex, this is one of the infantile primative reflexes that is present until 4 months
startle>abduction>adduction>crying |
moro
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marches up and down stairs (vs alternating)
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2 years
alternating occurs at 3 years |
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transfers objects from hand to hand
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6 months
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language disorders can affect what % of children?
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5 - 10%
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follows 1 step command with gesture:
follows 1 step command without gesture: follows 2 step commands |
12 months
14 months 24 months (2/2) |
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discriminate use of "mama" and "dada"; 3-5 words; jargoning
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12 months
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what are the two most common nongenetic causes of hearing loss in the newborn period?
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CMV and rubella
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uses spoon well, buttons
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3 years
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Sleep-Wake Patterns
At what age should an infant sleep a 5 hour stretch at night Healthy Term: 16-17 hrs 5-6 mo: able to self sooth back to sleep **otherwise parental participation to fall asleep becomes required at every awakening throughout the night** 12 mo: sleep 14 hrs per day, typically 2 naps 2 yr: 13 hr per day, typically 1 nap |
3-4 months
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nightmare or night terror
Late at night REM sleep Scared but consonable Clear recall of dream Reluctant to return to sleep Reassure the child |
nightmare
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nightmare or night terror
Early, usually within 4hrs of bedtime Partial arousal from deep REM sleep Disoriented, confused and inconsolable Usually no recall Easily return to sleep Ressure the parents |
night terror
Early, usually within 4hrs of bedtime Partial arousal from deep REM sleep Disoriented, confused and inconsolable Usually no recall Easily return to sleep Reassure the parents |
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characterized by difficulties in social interaction and by restricted, stereotyped interests and activities
no general delay in language or cognitive development |
Asperger's syndrome
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What is the overall population risk for autism?
Male predominance 3-4 : 1 female |
1 in 1,000
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if absent, this is the most robust clue of autism!
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joint attention
the process of sharing one’s experience of observing an object or event, by following gaze or pointing gestures. It is critical for social development, language acquisition, cognitive development… Most robust clue!! Calling another person’s attention to an object or event Bringing to show Empathy Included protodeclarative pointing -the use of the index finger to indicate an item of interest to another person. |
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what are theses?
Lack of gaze monitoring No protodeclarative pointing Delay in spoken language Not aware of others Lack of pretend play Does not play with peers, take turns Unusual finger mannerisms |
red flags for possible autism
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what are these?
No vocalizations by 6 mo No babbling by 12 mo No spontaneous phrases by 24 mo No sentences by 36 mo Loss of expressive speech Loss of comprehension |
red flags for language delay
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