Peds1test
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Opisthotonic | "Death pose" - hyperextension, spasticity; ween in CNS Infection, tetanus, phenothiazide intoxication
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| weak cry | seriously ill child
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| hoarse cry | laryngitis, epiglottis, foreign body, croup
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| high pitched cry | increased intracranial pressure
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| moaning cry | meningitis, toxic infant; **ER
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| Grunting cry | respiratory distress & heart failure; pneumonia; intestinal obstruction, sickle cell, skull fx, intussusception
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| infrequent cry | mental retardation, downs syndrome, hypothyoidism
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| excessive cry | colic, parental anxiety, maladjustment
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| how often do they cry an hour? | 10-15min
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| how often do they cry in a day | 2.5 hrs
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| colic | rule of threes
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| colic onset/duration | begins at 3 weeks of age, stops at 3 months
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| colic presentation | cry 3 hrs of nonstop crying at lease 3 days per week
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| folic acid deficiency | increases neural tube defects
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| bioenvironmental factors | drugs, alcohol, diet, heat
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| bioenvironmental factor | histone modifications
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| histone modifications | opens DNA making it available to turn genes on or off; only occurs at cytosine/guanosine locations
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| socioenvironmental | emotional/sensory deprivation may lead to decreased intellectual development
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| which motor skills correlate with intelligence | fine, not gross motor
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| "normal" | within 2 std dev of the mean of the population studied**
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| weight doubles by | 3-5 months
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| weight triples by | 1 year
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| breast fed babies 1st month | gain very rapidly
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| breast fed babies 6th month | slowed weight gain
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| do large babies follow the standard weight gains | no
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| which is the most important measurement | HC
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| HC during first 3 months | increases by 2cm/month
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| HC during months 3-6 | increases by 1 cm/month
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| HC during 2nd half of the first year | increases by 0.5cm/month
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| If baby starts with 13cm head, what will it be when the baby is 8 months? | 23 cm
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| when does the skull stop growing? | when the fontanelles close
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| when does the posterior fontanelle close by | 3-4months
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| when does the anterior fontanelle close by | 12-15 months
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| Length during 1st 3 months | increases 2in/month
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| length during months 3-6 | increases by 1 in/month
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| length during 2nd half of 1st yr | increases by 0.5in/month
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| what will the length of a 10 month old be if he started at 17inches? | 28 inches
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| growth rate of 1st year of life | grow about half the birth length
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| growth rate of 2nd year of life | grow half the 1st year
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| growth rate of 3rd year of life | grow half the 2nd year
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| growth rate of 4th year to puberty | same as 3rd year of life
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| growth of 1st yr of life | about 10 in
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| growth of 2nd yr of life | grow 5 in
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| growth of 3rd yr of life | grow 2.5 in
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| growth of 4th yr to puberty | grow about 2.5 in per year
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| predicted girl height - double at | 2 yrs
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| predicted boy height - double at | 18 months
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| moro reflex | primary
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| moro reflex | startle; eyes open, fingers spread and cry
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| moro disappears by | 5-6 months
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| rooting reflex | primary
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| rooting | stroke mouth and turns head toward the stroked side
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| rooting disappears by | 9months
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| palmar grasp | primary
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| asymmetric tonic neck | primary
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| palmar grasp | hand in palm or sole of foot and baby closes around it
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| palmar grasp disappears by | 5 months
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| asymmetric tonic neck | baby looks right, right arm sticks out and cant roll over
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| asymmetric tonic neck disappears by | 9 months
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| babinski reflex disappears by | 2 yrs
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| neck righting | secondary
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| parachute | secondary
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| neck righting | while supine, baby rotates trunk in the direction in which the head is turned to roll onto stomach
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| parachute | anterior 1st, then lateral then posterior parachute develops
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| anterior parachute develops at | 4-5 months
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| anterior parachute | can sit like gorilla with arms out but only until turns head and then falls over because no lateral parachute yet
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| 6-17 weeks | holds head up
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| 2-5 months | rolls over
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| which way to roll over is better | front to back
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| 5-8 months | sits unsupported
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| 5-10 months | stands
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| 7-10 months | creeps
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| 11-15 months | walks unassisted
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| 24-30 months | toilet trained
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| 4 months | reaches for object
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| 7 months | transfers object hand to hand
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| 9-10 months | thumbs and finger grasp (pincer)
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| begins by 12 months and all by 18 | scribbles spontaneously
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| 9-13 months | 1st word
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| 14-24 months | 1st phrase
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| 18-30 months | 1st sentence
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| 1 month | begins to mimic your mouth movements
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| 3-6 months | babbling
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| 9 months | babbling sounds like a language
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| 12 months | has own jargon, gestures, understands simple phrases like no, bye, bottle
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| 18 months | uses 6 meaningful words
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| 18 months | follows 1 step commands
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| 24 months | 50 word vocab
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| 24 months | uses simple 2 word phrases
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| 24 months | uses negative and possessives
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| 24 months | points to body parts
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| 30-36 months | names pictures
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| 30-36 months | follows 2 step commands
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| 36 months | uses 4 word sentences
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| 36 months | asks questions
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| 36 months | uses past and future tenses
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| 48 months | uses full sentences and has adult grammar
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| 48 months | differentiates and answers simple question
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| rear facing car seat until | 3 yrs
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| booster seat | if after 7 years and still under 4ft 9 in
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| allowed to sit in front of car | 13 yrs
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| 2nd overall cause of unintentional death | drowning
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| drowning | peaks in preschool and ten years
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| infants | drown in bath tubs
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| preschoolers | drown in swimming pools
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| preteens/adolescents | drown in natural bodies of water
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| cause of death due to fire | due to smoke inhalation or asphyxiation
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| suicide | 1 million children come home to a loaded gun unsupervised
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| highest suicide rates race | american indians
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| 1st cause of death in <1yr | inhalation/ aspiration
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| 2nd cause of death in <1 | mechanical suffocation
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| 3rd cause of death in <1 | MVA
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| 1st cause of death in preschool 1-4 | MVA
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| 2nd cause of death in preschool 1-4 | drowning
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| 3rd cause of death in preschool 1-4 | fire and burns
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| 1st cause of death in school age | MVA
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| 2nd cause of death in school age | drowning
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| 3rd cause of death in school age | fire and burns (5-9)
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| 4th cause of death in school age | firearms & homicide (10-14)
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| 1st cause of death in teens | MVA
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| 2nd cause of death in teens | firearms and homicide
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| 3rd cause of death in teens | suicide
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| hot water temp should be | 120 degrees
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| embryonic phase | 8-12 weeks of growth (gestation)
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| fetal phase | last 2 trimesters
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| circulatory development begins | at 4 weeks gestation
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| circulatory development attains final form | at 8-12 weeks gestation
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| 1st blood forming organ | connective tissue (then liver, spleen & bone marrow)
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| Fetal Hb at birth | 80%
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| fetal Hb at 20 weeks old | 5%
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| all primordial upper airway present | 5-6 weeks gestation
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| surfactant production begins | 22-24 weeks gestation
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| lung maturity permits survival | 27-28 weeks
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| bile formation & digestive enzymes | 12 weeks gestation
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| swallowing movements begin | 14 weeks gestation
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| meconium formation seen | 16 weeks gestation
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| weak active sucking & swallowing | 28-29 weeks gestation
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| neural tube development | 4 weeks gestation
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| cerebral hemispheres and ventricle form | 8-12 weeks gestation
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| palms and soles become reflexogenic | 9 weeks gestation
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| fetal movement aware to mom | 13-14 weeks gestation
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| fetal activity decreases & sluggish until birth | 15-16 weeks gestation
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| frontal, temporal, parietal, occipatal lobe development | 16 weeks gestation
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| grasp reflex formed | 17 weeks gestation
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| moro response begins | 25 weeks gestation
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| risk autism | advanced paternal age
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| risk schizophrenia | advanced paternal age
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| risk achondroplasia | advanced paternal age
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| risk neurofibromatosis | advanced paternal age
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| risk marfan syndrome | advance paternal age
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| risk hemophilia A & b | advanced paternal age
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| risk deuschends muscular dystrophy | advanced paternal age
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| risk neural tube defects | obese mother
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| risk ASD, VSD, cardiac abnormalities | obese mother
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| risk cleft lip | obese mother
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| risk anal rectal atresia | obese mother
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| risk limb abnormalities | obese mom
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| risk hydrocephalis | obese mom
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| risk neural tube defects | diabetic mom
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| diabetic mom | inhibits PAX3 gene
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| diabetic mom | large babies
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| risk asthma | AA mom who takes alot of acetaminophen during preg
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| risk ADHD | smoking mom
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| risk ADHD | mercury
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| TORCH | toxoplasmosis, other, rubella, cytomegalovirus, herpes
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| risk of Type II DM & obesity | smoking mom
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| PROM | premature rupture of membranes
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| when is a baby considered infected? | if PROM for >24 hrs
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| C section | if <39 weeks, increase risk of resp distress, infection, neonatal unit admission
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| toxemia | may lead to HTN and proteinuria - at risk for seizures
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| When do you do APGAR score | at 1 min and 5 min after delivery
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| A | appearance
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| p | pulse
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| g | grimace
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| a | activity
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| r | respirations
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| blue pale appearance | 0
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| body pink extremity blue | 1
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| all pink appearance | 2
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| absent pulse | 0
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| <100 bpm, irreg | 1
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| >100 | 2
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| normal HR | 140
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| no grimace to nasal catheter | 0
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| grimace to nasal catheter | 1
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| sneeze to nasal catheter | 2
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| limp tome | 0
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| some tome | 1
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| active motion | 2
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| absent respirations | 0
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| slow gasping | 1
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| good cry | 2
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| If APGAR almost all 1s, | score is 5
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| premature | delivered normally
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| premature | develop on time for age
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| small for gest age | never catch up while developing
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| small for gest age | big head
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| risk for small for gest age | HTN mom
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| risk for small for gest age | smoking mom
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| small for gest age | vasoconstriction from old mom with HTN or smoking cause decrease blood flow and decrease nutrition
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| large for gest age | very sick
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| large for gest age | needs to be on monitors, nasal O2 and IV
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| large for gest age | when cord cut, cuts off sugar supply but baby has too much insulin and seizes
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| post mature | decreased subcutaneous tissue, dry baby due to low nutrition due to placenta quitting
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| Skin exam | color, rashes, nevi
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| hemangiomas | most not present at birth
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| sucking baby | eyes open!
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| epicanthal folds | (nasal side) - seen in Downs Syndrome
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| Conjunctivitis on day 1 | m/c cause chemical (due to silver nitrates on skin around eye)
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| conjunctivitis on day 2 | m/c cause gonorrhea
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| conjunctivitis on day 3 or later | due to chlamydia **watch out for pneumonia!
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| Head exam | shape, fontanelles, swelling, lesions, face
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| frontal bossing | prominence of frontal bones seen with congenital syphilis
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| cephalohematoma | blood between the skull and periosteum - at risk for jaundice
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| caput succadeneum | fluid extraperiosteal below scalp and above periosteum
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| unilateral lacrimal duct obstruction | another cause of conjunctivities
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| what happens if pressure at inner canthus doesnt open lacrimal duct and the baby is <1 yr? | the optho will not probe it because too young
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| mouth exam | palate, tongue, ebsteins pearls, supernummerary teeth
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| palate | feel to make sure its intact - may have submucosal cleft
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| submucosal cleft | looks intact but isnt and will create speech problemes
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| high arched palates | associated with developmental and congenital anomalies
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| ebsteins pearls | occlusion cysts midline palate or on gum, look like teeth, benign, rupture and go away
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| supernummerary teeth | babys permanent teeth - no problem
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| neck exam | masses, sinus tracts, clavicles
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| clavicle fractures | many miss this! palpate for crepitus, heal spontaneously
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| masses | SCM lesions, branchial cleft rests; goiter - mom may be hypothyroidism
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| cystic hygroma | seen laterally
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| sinus tracts | remnants of fetal development - dont cause major problems
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| thyroglossal ducts | normally travels down but may not finish and may find mass/ draining sinus midline - dont remove until you know if it is the thyroid since they are small in newborns!
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| newborn breast engorgement | may leak milk as mom breast feeds - normal due to moms hormones
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| normal resp rate of newborn | 40
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| tachypnea of newborn | >60
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| Only congenital anomaly you can rule out with a stethoscope | coarctation of aorta
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| coarctation of aorta | decreased pules in LE femoral pulses
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| Umbilicus vessels | 3
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| umbilical arteries | 2
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| umbilical veins | 1
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| umbilical artery | carries blood to placenta
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| umbilical vein | carries O2 blood to fetus!
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| single umbilical artery | possible malformation in Cardiovascular, CNS, GI, Renal, Karyotypic syndromes
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| Male genital exam | make sure testes are down, look for hydrocele, hernia, hypospadius
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| hypospadius | opening of urethra is any place other than tip; if severe, cant have circumscision because you need the skin to repair it
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| female genital exam | normal to have mucoid or bloody discharge in breast fed babies due to maternal hormones
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| Back exam | look for any skin abnormality overlying the cord because the skin and NS are derived from the same germ layer (neurocutaneous disorders)
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| hips | dislocation, especially in breech deliveries - make sure you call it developmental dysplasia of hips (not congenital dislocation of hips because not always found at birth)
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| m/c finding with dysplastic hip | abduction
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| Galazzi sign | knees bent with feet on mattress - is one knee higher than the other? the lower knee is the subluxed hip
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| barlow maneuver | attempt to dislocate the hip - you abduct and push up and feel it slip out the glenoid
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| ortolani sign | when you bring the leg back down and hear the thud when it goes back - relocating the hip
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| developmental dysplasia of hips | evaluate the hips every visit until they walk
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| when will the cord fall off around? | 2-6 weeks
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| bowel movements | normal can be 7/8 per day due to gastrocolic reflex or 1 per week when breast feeding because it is mostly water
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| baby doesnt cry because has gas | passing gas because right before they cry they take a deep breath in and bear down
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| when do you do a spinal tap and check for sepsis? | if baby is <1 month and has 101 F; <2 months and has 102 F; <3 months and has 103 F
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| elevated bili | 1.increased production - due to increased hemolysis
2.impaired handling - due to immaturity or liver disease
3.increased reabsorption from intestine
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| Normal adult Hb | 12-15
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| normal baby Hb | 20 HbF (more Hb) because placental O2 is lower therefore once born, air O2 is higher and they break down the extra blood
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| septic jaundice | high direct bili
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| polycythemia | due to delayed cord clamping (increases blood volume) can cause jaundice
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| Jaundice of term infants | begins 2-3 days and gone by day 7
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| premies jaundice | begins day 4-5 and gone by day 14
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| c-section <38 weeks | increase bili and jaundice because more immature liver
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| when do we worry about bili? | if it rises >7mg/day, >12mg by 48 hrs or >15 by 72 hours
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| Jaundice | starts at head and works down so check soles to see how far along they are
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| kernicteris | yellow staining of brain
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| high direct bili | very bad!
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| high direct bili | caused by sepsis, infection, hemolytic disease, cystic fibrosis
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| Increased indirect bili | most are fine; it is physiologic but look at Coombs test
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| Coombs test | isoimmunization; if positive have Rh or ABO incompatablility
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| ABO incompatability | mom is O because has anti a and anti b and baby is either a or b
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| If coombs was negative | measure Hb next - if Hb high, baby is polycythemic (tomato)
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| causes of high Hb | twin transfusion, maternal-fetal transfusion, delayed cord clamping, small for gest age
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| If Hb low | look at reticulocyte count - if normal, there is nothing wrong with the RBC and high bili due to cephalohematoma, high enterohepatic circulation, infreq stool, bowel obstr, neonatal asphyxia (no heart beat)
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| If reticulcytes high | ask hematologist to look at smear
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| characteristic smear cells | spherocytosis (abnormal, rupture in spleen)
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| how is spherocytosis dx? | family hx of anemia
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| nonspecific smear cells | G6PD deficiency (causing the increased indirect bili)
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| risks for hyperbili | -born before 38 wks
-sibling w/jaundice
-mother exclusively breastfeeding - causes excess hormones to be metabolized by immature liver
-visibly jaundice at <24 hrs
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| risk for hypoglycemia | small for gest age
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| risk for hypoglycemia | diabetic moms
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| risk for hypoglycemia | premie, postmatures, stressed infants
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| hypoglycemia symptoms | may be asymptomatic
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| lumbar puncture | differentiates between sepsis and meningitis
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| transplacental bacterial infections | syphilis, lyme, TORCH
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| m/c cause of cerebral palsy | maternal infections while preg due to cytokines
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| number 1 etiology of sepsis | group B strep (women are colonized in vag flora)
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| early onset sepsis | types I and II; prevented by IV ABX to mom & screenings
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| late onset sepsis | type III; presents as pneumonia and you die
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| respiratory distress syndrome | most freq cause of resp distress in newborn; results from lack of surfactant
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| xray of respiratory distress syndrome | ground glass appearance
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| tx resp distress syndrome | tx like baby has GroupB strep because the xray looks the same
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| most common pneumonia | Group B strep
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|
||||
| Crack/cocaine use | 3rd leading cause of birth defects assoc with mental retardation
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|
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| Crack cocaine use clinical findings | microcephaly, short palpebral fissures, flat philtrum, thin vermillian border, migcrognathia, low set ears
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|
||||
| crack cocaine assoc findings | intrauterine growth retardation, prematurity, lethargic, hypertonic, tremors,increased CNS injuries
🗑
|
||||
| Heroin&Methadone | infants go through withdrawal; with methadone symptoms are more severe and longer - irritable, tremors, seizures, high-pitched cry
🗑
|
||||
| barbiturates | symptoms delayed; due to the slow metabolism & excretion by the immature liver
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|
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| opiods | increased risk for resp distress & seizures
🗑
|
||||
| leading cause of death in 1st yr of life after newborn period | SIDS; most common between 2-6mos
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|
||||
| cows milk based formula brands | enfamil, similac, goodstart
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|
||||
| cows milk based formula protein source | skim milk (cow)
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|
||||
| cows milk based formula fat source | soy, coconut, safflower oils
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|
||||
| cows milk based formula carb source | lactose
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|
||||
| Lactose | the sugar in breastmilk is lactose so you cant be lactose intolerant at birth
🗑
|
||||
| 1 kg | 2.2lbs
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|
||||
| 1 meter | 39.37 in
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|
||||
| greatest factor correlating with the development of obesity | presence of a TV in a childs bedroom
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|
||||
| marasmus | severe state of caloric deprivation
🗑
|
||||
| marasmus exam | failure to gain weight; distended or flat ab, muscle atrophy, hypotonia, edema, hypothermia
🗑
|
||||
| kwashiorkor | inadequate protein intake with almost normal caloric intake
🗑
|
||||
| kwashiorkor exam | **edema, diarrhea
-lethargy, hyperactivity, distended ab, skin rash, decrease hair coloration, anemia
🗑
|
||||
| most common type of dehydrations | isotonic dehydration
🗑
|
||||
| mild dehydration | 3-5%
🗑
|
||||
| dont look sick | mild dehydration
🗑
|
||||
| normal physical | mild dehydration
🗑
|
||||
| normal or increased pulse | mild dehydration
🗑
|
||||
| increased thirst | mild dehydration
🗑
|
||||
| decreased urine output | mild dehydration
🗑
|
||||
| moderate dehydration | 7-10%
🗑
|
||||
| tachycardia | mod dehyd
🗑
|
||||
| little to no urine output | mod dehyd
🗑
|
||||
| irritable or lethargic | mod dehyd
🗑
|
||||
| sunken eyes | mod dehyd
🗑
|
||||
| depressed anterior fontanelle | mod dehyd
🗑
|
||||
| decreased tears, dry mucous membranes | mod dehyd
🗑
|
||||
| mild loss of skin turgor, delayed cap fill, skin cool and pale | mod dehyd
🗑
|
||||
| severe dehydration | 10-15%
🗑
|
||||
| rapid weak pulse | sev dehyd
🗑
|
||||
| low BP | sev dehyd
🗑
|
||||
| no urine output | sev dehyd
🗑
|
||||
| very sunken eyes, markedly sunken anterior fontanelle | sev dehyd
🗑
|
||||
| absence of tears, parched & dry mucous membranes | sev dehyd
🗑
|
||||
| marked loss of skin turgor, very delayed cap refill, skin cold & mottled | sev dehyd
🗑
|
||||
| shock | >15%
🗑
|
||||
| to restore shock/sever dehydration blood volume | 20 ml/kg every 20 min until bp normal
🗑
|
||||
| hypertonic dehydration deficit over 48hrs | Na 158-170
🗑
|
||||
| hypertonic dehydration deficit over 72 hrs | Na 171-183
🗑
|
||||
| hypertonic dehydration deficit over 96 hrs | Na181-196
🗑
|
||||
| hypertonic dehydration maintenance | keep same
🗑
|
||||
| renal failure/no urine output | deficit remains same
🗑
|
||||
| maintenance is oliguric | half normal maintenance
🗑
|
||||
| K replacement | cant give until urine output has been established
🗑
|
||||
| m/c cause cerebral palsy outside of the neonatal period | head injuries secondary to abuse
🗑
|
||||
| 2-3 yr old sexual abuse | if play takes on aspects of shame, secrecy and obsession
🗑
|
||||
| 3-4 yr old sexual abuse | if have a clear focus on sexual intercourse red flag
🗑
|
||||
| masturbation | normal in 2-4 yrs
🗑
|
||||
| 5-9 yr old sex abuse | red flag if sex play with different ages, or includes force, threats, harm or secrecy
🗑
|
||||
| parvovirus 19 | 5th disease
🗑
|
||||
| RNA virus | rubeola
🗑
|
||||
| rubeola | measles
🗑
|
||||
| rna virus | rubella
🗑
|
||||
| rubella | german measles
🗑
|
||||
| RNA virus - paramyxovirus | mumps
🗑
|
||||
| GAS | scarlet fever
🗑
|
||||
| GAS | bacterial pharyngitis/tonsilitis
🗑
|
||||
| GBS | meningitis <2yrs
🗑
|
||||
| pseudomonas | otitis externa
🗑
|
||||
| viral disease | sinusitis
🗑
|
||||
| adenovirus | pink eye
🗑
|
||||
| adenovirus | parhyngitis/tonsilitis
🗑
|
||||
| s. aureus | periorbital cellulitis
🗑
|
||||
| s. aureus | osteomyelitis
🗑
|
||||
| s. aureus | septic arthritis
🗑
|
||||
| s. pneumoniae | meningitis >2yrs
🗑
|
||||
| s. pneumoniae | bacterial sinusitis
🗑
|
||||
| s. pneumoniae | acute otitis media
🗑
|
||||
| eustacian tube dysfunction/allergies | otitis media w/effusion
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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