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204 Cards in this Set
- Front
- Back
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When should a complete physical exam be done on a newborn?
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Within the first 24 hours of life
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What is the purpose of the physical exam in the newborn period?
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-Detect for anomalies
-Identification of problems (birth injuries, jaundice, or cardiopulmonary disorders) |
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What are the key general aspects of the neonatal physical exam?
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-Head to toe
-Between the legs -up the back **Don't forget to turn the baby over** |
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What are some examples of pregnancy complications that would be important to include in the neonatal history?
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-Gestational diabetes
-hypertensive disorder (may affect fetal growth or lead to other complications) |
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Why must maternal medications be included in a neonatal history?
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-Intraueterine effects
-excreted in breast milk |
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What are the important maternal illness prior to pregnancy?
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SLE or idiopathic thrombocytopenic purpura
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List the routine laboratory tests to conduct in pregnancy?
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-Maternal blood type, antibody screen
-Rhesus (Rh) type -Rubella status (immune or nonimmune) -syphillis screen -hepatitis B surface antigen |
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List the parts of quadruple screen.
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-Alpha-fetoprotein
-Human chorionic gonadotropin (hCG) -unconjugated estriol (uE3) -inhibin A |
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What is alpha-fetoprotein (AFP)?
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It is a protein produced by the baby
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hCG is a hormone that is produced in the ____?
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placenta
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Unconjugated estriol is a form of the hormone ____ produced by the __ and the ___.
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estrogen; fetus; placenta
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Where is inhibin A produced?
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in the placenta
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List the 4 aspects of the general approach to the neonatal exam
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-appearance and posture
-respiratory effort -position -color |
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The average weight of newborns is ___kg with a normal range between ___ and ___ kg.
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3400; 2500; 4300
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True or false: it is normal for a newborn to lose more than 3% of their body weight in the first 24 hours of life?
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FALSE! under 3%
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The average LENGTH of the newborn is ___cm with a normal range from __ to __ cm.
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49.6; 45; 54
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What are the differential diagnoses for a child born < 45cm in length?
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-prematurity
-dwarfism -turners -osteogenesis imperfecta |
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What disorder should be considered at birth if the child is > 54 cm?
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Marfan's
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What is the normal head circumference for a newborn at term?
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32-38cm
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Head size and size of the ___ will vary according to age, sex and ___
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fontanelles; ethnicity
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What is the name of soft area of skull bone?
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Craniotabes
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Where are craniotabes often found?
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parietal region
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What does a craniotabe feel like?
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Sensation of a ping-pong ball when depressed
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When is craniotabe often seen?
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-premature infants
-found in term infants whose head rested on the pelvic brim during the last few weeks of gestation |
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Caput succedaneum often crosses the __ __ and may be associated with ___ and ecchymosis.
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suture line, petechiae
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What head trauma is characterized by a poorly demarcated soft tissue swelling?
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caput succedaneum
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Craniotabes can be a pathologic finding in ___ and ___, although it usually occurs in normal infants.
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syphilis; rickets
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True or false: cephalohematoma is more common than caput?
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FALSE
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What is the name of the head trauma that is caused by an accumulation of blood or serum above the periosteum after a prolonged labor?
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caput succedaneum
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What may cause a cephalohematoma?
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Prolonged labor or instrumentation
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Cephalohematoma are often well ___ with fluctuant ___ and does not ___ ___ ___.
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demarcated; swelling; cross suture lines
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If a newborn has a skull fracture, elevated ridge or organizing tissue, what form of head birth trauma may they have experienced?
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cephalohematoma
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Cephalohematoma are often well ___ with fluctuant ___ and does not ___ ___ ___.
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demarcated; swelling; cross suture lines
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Linear fractures causing cephalohematoma need report Xray of the head to rule out ____ ___
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leptomeningeal cysts
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Pallor in infants is often associated with ___.
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low hemoglobin
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What might a child's skin look like with hypoxemia ?
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cyanotic
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___ skin color is associated with polycythemia.
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plethora
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If a newborn is juandice, then they most likely have elevated ___
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bilirubin
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A slate grey color to the skin in a newborn is often associated with ____
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methemoglobinemia
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TorF: acrocyanosis in the newborn in pathological?
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False
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What are the 7 harmless skin disorders of a newborn?
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1. Related to fetal monitor, electrodes, amniocentesis
2. mongonlian spots 3. acrocyanosis 4. cutis marmorata 5.Harlequin color change 6. subcutaneous fat necrosis 7. erythema toxicum |
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What is the name of the epidermal inclusion cysts seen in 40-50% of infants
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milia
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What skin disorder in infants is do to obstruction of the eccrine sweat glands
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Miliaria
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What are cyrstallina?
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superficial obstruction
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WHat is the name of a deep skin obstruction in newborns?
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rubra
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What is milia?
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white papules frequently found on the nose and cheeks and result from retention of keratin and sebaceous material in the pilosabaceous follicles
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How long does milia tend to last in newborns>
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several weeks
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Miliaria are ___ vesicles on the forehead, __ and ___
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pinpoint; scalp and skinfolds
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Miliaria often clear after __ week
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1
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Miliaria are related to sweat ___ and described as __ heat. What are the recommendations for treatment?
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retention; prickly; avoid excessive heat and use cetaphil
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How is miliaria crystallina described?
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small thin-walled vesicles resembling dewdrops without inflammation
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Descrive miliaria pustulosa
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consists of pustules with an erythematous base and is due to localized inflammation
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20-37% of neonates with congenital exophytic scalp nodules with have...
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underlying CNS disease
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What is this an image of?
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harlequin color change
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What is this an image of?
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Acne neonatorum: neonatal acne
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Describe the characteristics of acne neonatorum.
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-seen in 20% of infants
-resolves in the first few months of life -very common -resembles acne and appears between 2-4 weeks -no therapy |
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What treatment option is rarely used for neonatal acne>
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mild keratolytic (benzoyl peroxide)
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Neonatal acne must be differentiated from ___ ___ __, which resolves within weeks.
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Sebaceous Gland Hyperplasia
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What is the name given to a generalized erruption of superficial pustules overlying hyperpigmented macules?
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transient pustular melanosis
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What ethnicity is at most risk for transient pustular melanosis?
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african american newborns
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pustules of transient pustular melanosis usually are removed with the ___ ___ so that only macules remain.
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first bath
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TorF: transient neonatal pustular melanosis is benign?
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True
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transient neonatal pustular melanosis is often seen in ___ to ___% of newborns
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0.2 to 4
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TNPM are small ___, generally present at birth, containing __ and no ___
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vesicopustules; WBCs; organisms
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the intact vesicle of TNPM ruptures to reveal a pigmented __ surrounded by a thin __ __
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macule; skin ring
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The most common newborn rash is ...
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erythema toxicum neonatorum
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describe the appearance of erythema toxicum neonatorum
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Blotchy macular erythema which can develop into fine 1-3mm pale yellow papules, pustules on erythematous base
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erythema toxicum neonatorum of effects the ___ follicles?
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pilosebaceous
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what are in the lesions of erythema toxicum neonatorum?
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eosinophils
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erythema toxicum neonatorum frequently spares the __ and the ___
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palms and sole
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erythema toxicum appears up to __ days later in newborns?
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14
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Lanugo is more pronounced in __, __, and __ infants
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premature; black; hispanic
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List the characteristics of vernix caseosa.
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-excessive in premature
-absence in post-mature -meconium stained in intrauterine distress -yellow: hyperbilirubinemia |
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What are the 4 pigmentation variations found in newborns.
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-mongonlian spots
-wide spread bruising -port wine stain -albinism |
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Macrostomia is often seen in newborns with ___
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mucopolysaccharidoses
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What disorder of the palate is often found in infants with fetal alcohol syndrome?
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fish mouth
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___ ___ are small, white, benign inclusion cysts on the palate and are clustered at the MIDPOINT of the junction between the soft and hard palate
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eptsein pearls
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What are the small bluish white swellings of variable size on the floor of the mouth representing a benign mucuous gland retention cysts
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ranula
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Natal teeth often occur in the __ __ __ region and frequently are ___.
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lower central incisor; bilateral
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What disorders of the tongue are often seen in newborns
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-macroglossia
-hypothyroidism -nucopolysaccharideoses |
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Why are natal teeth often a risk in newborns?
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there is a risk of aspiration if they are loosely attached
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Natal teeth often present in newborns with ___ ___
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cleft palate
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Microganthia often occurs with which syndromes
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-pierre-Robin syndrome
-treacher-collins syndrome |
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What disorder is attributed to the most common brachial injury?
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Erb-duchenne palsy
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Which vertebrae are involved with erb-duchenne palsy?>
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C5-6 and sometimes 7
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What is the position of the arm of a child with erb-duchenne palsy?
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Arm is abducted and internally rotated with elbow extension, wrist flexion
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TorF: a child with erb duchenne palsy will not have an intact grasp reflex?
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FALSE
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What is the common position of the hand of a child with C7 involvement of erb-duchenne palsy?
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waiter tip
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TofF: Klumpke's palsy is more common than erb-duchenne palsy?
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FALSE! much rarer: <1% of injuries
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which vertebrae are involved in klumpke's palsy?
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C8 and T1
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ToF: there is an absence of the grasp reflex in klumpke's palsy?
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TRUE
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in klumpke's palsy the hand is ___ with no __ movement at the wrist and a paralysis of the __ __
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paralyzed; voluntary; entire arm
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Which population has a greater occurance of supernumerary digits at birth?
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african americans
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supernumerary digits tend to be ___ and lateral to the __ digit that is attached by a ___
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hereditary; 5th; peduncle
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ToF: supernumerary digits are the same as true extra digits and may have a nail
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FALSE: they differ from true extra digits but CAN have a nail
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A simian crease is often associated with which disorder
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trisomy 21
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What is this an example of?
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supernumerary digit
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What is this?
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Simian crease
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The umbilical cord should have how many vessels?
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AVA
2 arteries and 1 vein |
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What % of newborns present with a single umbilical artery and what is it associated with?
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0.2 to 1%; associated with renal abnormalities in 7% of these infants.
increased rate of chromosomal and other congenital anomalies |
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Which infants have a higher incidence of single umbilical arteries?
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-SGA
-premature infants -twins |
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the most commonly affected organs of single umbilical artery are the ___, __, __
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heart; GI tract; CNS
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What must the HCP ensure when a newborn has a single umbilical artery?
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there is no connection to intraabdominal contents
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Can the liver be palpated in newborns? if so how big is it?
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Yes: 2cm below the costal margin
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Where should the HCP start when assessing the spleen of an baby?
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RLQ and working up towards the left midaxillary
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What should the HCP be alert for if the spleen of a newborn is felt?
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Congenital infection or extramedullary hematopoiesis
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What is the likely diagnosis of a newborn with limited hip abduction?
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DDH
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What is the name of the common disorder that causes the intestinal contents of of a newborn to protrude out of the umbilicus?
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umbilical hernia
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Where should the hand be placed during ortolani and barlow?
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on the knee and the greater trochancter
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What are the 3 major steps in assessing for DDH?
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1. hip abduction: should go 160-180 degrees symmetrically
2. Ortolani/Barlow 3. Galeazzi/Allis |
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Should an ultrasound of an infant with suspected DDH be done in the first 2 weeks of life? why or why not?
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No; get a lot of false positives
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Children that are toe walkers often have __ or short __ and are at greater risk for __.
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CP; tendons; DDH
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Which test (Ortolani/Barlow) places the dislocated hip back into the socket?
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ortolani
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What is the minimum length that a newborn boy's penis should be?
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2cm. 1 inch!!
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Ambiguous genitalia in males will have ___ at birth
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micropenis
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Which baby boys cannot be circumsized?
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those that don't have an opening at the tip of the penis
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What is the equation for term normal penis size?
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3.6 +/- 0.7cm (2SD = 1.4) so 2.2cm is the minimum length
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what are the possible causes for micropenis in newborns?
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reduced androgen effect or reduced growth hormone during 2nd and third trimester
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What aspects of the male genitalia should be inspected at birth?
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glans, urethral opening, prepuce, shaft, and circumcised should be assessed for edema, incision and bleeding
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A full tern infant boy should have __ pigmentation and a fully __ scrotum.
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brown; rugated
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When do the testes fall?
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32 weeks
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True or false: retractile testes can be pushed down?
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True
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How should the HCP assess the testes?
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Start at the ischial tuberosity and push and push as they move down to the testes until they grab and hold them.
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At what age should the testes remain in the scrotum?
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age 1
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the ___ of the testes is a clothes line and they travel down it to the scrotum?
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gubernculum
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What is vanishing testes syndrome
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The baby has them and then they lose them. They will have an underdeveloped scrotal sack as they grow
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What treatment has been found to help with retractile and ectopic testes?>
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HCG helps them descend
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What is cryptorchidism?
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undescended testes and the scrotum of the neonate is often underdeveloped
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Cyrtorchidism is often 10 times more common in ___ babies
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premature
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If a girl presents with an inguinal hernia, what must she be assessed for?
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Turner's syndrome
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What is an inguinal hernia
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Intestine goes through and above the top of the scrotal sack and it feels squishy and air filled like "rice krispies"
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Inguinal hernias occur 60% of the time on the __ side of the body?
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right
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inguinal hernia are more common in (boys/girls)
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boys
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Term or preterm infants have a higher rate of inguinal hernias?
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preterm! 10x higher
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What are the important aspect in assessing female genitalia at birth?
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labia, clitoris, urethral opening, and external vaginal vault
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Which organ of the female genitalia is enlarged in premies>?
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the clitoris
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What is the name of the white discharge found in babies from the maternal hormone?
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leukoria
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TorF: hymen tags that are seen on female infants are not normal and should be assessed>/
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False: very common and they regress around age 5
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BE ABLE TO LABEL VAGINAL OPENINGS For The FINAL!
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What is hypertrichosis?
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troughs of hair on the skin overlying the spine
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What are the names of the fatty pads that lay over the spine>
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lipomas
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List the 5 overlying cutaneous markers for spinal problems?
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1. Hypertrichosis
2. lipomas 3. lipomyelomeningeocele 4. lare hemangiomas 5. anal verge |
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If a child has large dimples more than 2.4 cm away from the anus and lack of reflexes, what might they have?
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spina bifida occulta
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ToF; occult lesions on the spine may be asymptomatic?
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true
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What are the factors to assess for during inspection of the feet
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-syndactyly
-polydactyly -rocker bottom feeter |
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which syndrome is associated with rocker bottom feet?>
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trisomy 18
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Which form of syndactyly is not pathologic?
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when it occurs between the 2nd and 3rd toe. it is a minor phenotypic variation and often common
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It is not common to have syndactyly between the __ and ___ toes and should be referred to surgery.
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Big and 2nd
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What is metatarusus adductus often associated with?
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fix intrauterine position. Less common now that children are placed on their back
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What is talipes equinovarus?
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club feet
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What are the specific aspects of posturing in club feet?>
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-toes down
-heels up -malrotation of the calcaneus |
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in club feet the child with have fixed __ of the foot or __ of the foot.
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position; inversion
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Describe the tonic neck reflex
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-increase tone
-leg extension of side of head direction -flexion in contra lateral arm and leg |
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What is the stepping and walking reflex?
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range for minimal weight bearing to several brisk steps with plantar stimulation
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The moro reflex appears at __ weeks and dissapears at __ to __ months
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37; 3-6
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Tonic neck reflex emerges at __ weeks and is gone at __ months
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35; 6
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when does the palmer grasp reflex start and stop?
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28 weeks; 2-3 months
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When does a cortical thumb ofthen go away?
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2 months
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The ___ reflex appears at 37 weeks and leave at 2-4 months
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stepping
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which reflex starts at 32 weeks and never leaves?
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pupillary reflex
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the ankle clonus reflex can have __ to __ beats; appears at __ week and leaves at __ months
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5-10
33-35 1 month |
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When does the rooting reflex disappear?.
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3-4 months
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What is the name of the reflex that when the babies palm is grasped during nursing it will increase the suck?
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Bapkin reflex
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What disorder do you see a change from hypotonia to hypertonia?
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CP
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Which is more common hypo or hypertonia?
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Hypotonia
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What are the physical assessment features of neurological impairment?
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-hypotonia
-weakness or decreased strength -asymmetry of muscle tone and/ movement -alteration in LOC -seizures -single or multiple cranial nerve involvement -fasciculation |
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What are the assessment tools for reporting gestational age?
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Dubowitz and Ballard
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How is Ballard assessed>?
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-6 neuromuscular maturity signs
-6 physical maturity signs -best done at birth or within 1st 24 hours |
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ToF: the closer a baby is to term at birth the less likely they are to to have a positive scarf sign?
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true
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According to ballard, do premies bring their heels to their ears easily?
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yes
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What degree can a full term baby flex their hand down?
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zero degrees
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to be LGA the baby must be > __% for weight?
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90
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SGA = < ___% for weight
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10
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What disorder do you see a change from hypotonia to hypertonia?
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CP
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Which is more common hypo or hypertonia?
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Hypotonia
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What are the physical assessment features of neurological impairment?
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-hypotonia
-weakness or decreased strength -asymmetry of muscle tone and/ movement -alteration in LOC -seizures -single or multiple cranial nerve involvement -fasciculation |
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What are the assessment tools for reporting gestational age?
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Dubowitz and Ballard
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How is Ballard assessed>?
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-6 neuromuscular maturity signs
-6 physical maturity signs -best done at birth or within 1st 24 hours |
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ToF: the closer a baby is to term at birth the less likely they are to to have a positive scarf sign?
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true
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According to ballard, do premies bring their heels to their ears easily?
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yes
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What degree can a full term baby flex their hand down?
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zero degrees
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to be LGA the baby must be > __% for weight?
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90
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SGA = < ___% for weight
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10
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Babies that are born small, but look older most likely suffered from ___ ___ ___.
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intrauterine growth restriction
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IUGR happens in __ to __% of fetuses.
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4-8
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ToF: SGA = IUGR
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False, IUGR can cause SGA but not the other way necessarily
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If a babies rate of growth was less than their predetermined genetic potential they may have ___
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IUGR
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In an infant has a symmetric/total effect lack of growth, they suffered from an ___ insult of IUGR
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early
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What might a child look like that grew through a late onset of IUGR?
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BIg head and a small body
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what are some common causes of early insults of IUGR?
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-infection
-chemical teratogen -chromosomal abnormality |
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What are the common causes of late insult IUGR?
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-uteroplacental insufficency
-congenital malformation -brain sparing: normal head circumference |
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What is the pear analogy that helps differentiate the side of paralysis in children?
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the stem of the pear is the side of the paralysis
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A finding of sunsetting eyes in term babies may be indicative of ...
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-hydrocephalous
-increased ICP -kernicterus |
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What is this image showing? Is this pathologic?
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Sail sign of the thymus gland. It is a normal finding until age 2 and is observed more often on the right side.
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What is the image showing? What are the associated findings with this finding.
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Overlapping fingers called camptodactily. Often associated with trisomy 13 (patau syndrome)
Trisomy 18 (Edward syndrome) |
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What is a normal cardio thoracic ratio in a newborn's heart?
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<0.6
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What is the number 1 fracture in newborns?
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clavicle
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ToF: clavicle fractures in newborns are often very difficult to heal and are a long process of recovery?
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FALSE!
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What are are the symptoms post clavicle fracture?
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-asymmetric moro reflex and it can feel like crepitus under the skin as it heals
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What are the common causes of clavicle fractures in children?
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History of difficult delivery
-irregularity in contour -shortening, -tenderness -crepitus on palpation |
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What are wormian bones?
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sutural bones that are small, irregular bones that occur most often in the lamboidal sutures
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What are wormian bones often found to be associated with>
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-diseases manifesting with delayed or defective calvarial ossification, widened or delayed closure of cranial sutures, or delayed closure of the fontanelles
-Congenital hypothyroidism -cleidocranial dysplasia -osteogenesis imperfecta -congenital hypophosphatasia |
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wormian bones often occur over ___ sutures
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lambdoidal
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What is the white arrow pointing to?
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Wormian bones
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