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Peds1test
| Question | Answer |
|---|---|
| Opisthotonic | "Death pose" - hyperextension, spasticity; ween in CNS Infection, tetanus, phenothiazide intoxication |
| weak cry | seriously ill child |
| hoarse cry | laryngitis, epiglottis, foreign body, croup |
| high pitched cry | increased intracranial pressure |
| moaning cry | meningitis, toxic infant; **ER |
| Grunting cry | respiratory distress & heart failure; pneumonia; intestinal obstruction, sickle cell, skull fx, intussusception |
| infrequent cry | mental retardation, downs syndrome, hypothyoidism |
| excessive cry | colic, parental anxiety, maladjustment |
| how often do they cry an hour? | 10-15min |
| how often do they cry in a day | 2.5 hrs |
| colic | rule of threes |
| colic onset/duration | begins at 3 weeks of age, stops at 3 months |
| colic presentation | cry 3 hrs of nonstop crying at lease 3 days per week |
| folic acid deficiency | increases neural tube defects |
| bioenvironmental factors | drugs, alcohol, diet, heat |
| bioenvironmental factor | histone modifications |
| histone modifications | opens DNA making it available to turn genes on or off; only occurs at cytosine/guanosine locations |
| socioenvironmental | emotional/sensory deprivation may lead to decreased intellectual development |
| which motor skills correlate with intelligence | fine, not gross motor |
| "normal" | within 2 std dev of the mean of the population studied** |
| weight doubles by | 3-5 months |
| weight triples by | 1 year |
| breast fed babies 1st month | gain very rapidly |
| breast fed babies 6th month | slowed weight gain |
| do large babies follow the standard weight gains | no |
| which is the most important measurement | HC |
| HC during first 3 months | increases by 2cm/month |
| HC during months 3-6 | increases by 1 cm/month |
| HC during 2nd half of the first year | increases by 0.5cm/month |
| If baby starts with 13cm head, what will it be when the baby is 8 months? | 23 cm |
| when does the skull stop growing? | when the fontanelles close |
| when does the posterior fontanelle close by | 3-4months |
| when does the anterior fontanelle close by | 12-15 months |
| Length during 1st 3 months | increases 2in/month |
| length during months 3-6 | increases by 1 in/month |
| length during 2nd half of 1st yr | increases by 0.5in/month |
| what will the length of a 10 month old be if he started at 17inches? | 28 inches |
| growth rate of 1st year of life | grow about half the birth length |
| growth rate of 2nd year of life | grow half the 1st year |
| growth rate of 3rd year of life | grow half the 2nd year |
| growth rate of 4th year to puberty | same as 3rd year of life |
| growth of 1st yr of life | about 10 in |
| growth of 2nd yr of life | grow 5 in |
| growth of 3rd yr of life | grow 2.5 in |
| growth of 4th yr to puberty | grow about 2.5 in per year |
| predicted girl height - double at | 2 yrs |
| predicted boy height - double at | 18 months |
| moro reflex | primary |
| moro reflex | startle; eyes open, fingers spread and cry |
| moro disappears by | 5-6 months |
| rooting reflex | primary |
| rooting | stroke mouth and turns head toward the stroked side |
| rooting disappears by | 9months |
| palmar grasp | primary |
| asymmetric tonic neck | primary |
| palmar grasp | hand in palm or sole of foot and baby closes around it |
| palmar grasp disappears by | 5 months |
| asymmetric tonic neck | baby looks right, right arm sticks out and cant roll over |
| asymmetric tonic neck disappears by | 9 months |
| babinski reflex disappears by | 2 yrs |
| neck righting | secondary |
| parachute | secondary |
| neck righting | while supine, baby rotates trunk in the direction in which the head is turned to roll onto stomach |
| parachute | anterior 1st, then lateral then posterior parachute develops |
| anterior parachute develops at | 4-5 months |
| anterior parachute | can sit like gorilla with arms out but only until turns head and then falls over because no lateral parachute yet |
| 6-17 weeks | holds head up |
| 2-5 months | rolls over |
| which way to roll over is better | front to back |
| 5-8 months | sits unsupported |
| 5-10 months | stands |
| 7-10 months | creeps |
| 11-15 months | walks unassisted |
| 24-30 months | toilet trained |
| 4 months | reaches for object |
| 7 months | transfers object hand to hand |
| 9-10 months | thumbs and finger grasp (pincer) |
| begins by 12 months and all by 18 | scribbles spontaneously |
| 9-13 months | 1st word |
| 14-24 months | 1st phrase |
| 18-30 months | 1st sentence |
| 1 month | begins to mimic your mouth movements |
| 3-6 months | babbling |
| 9 months | babbling sounds like a language |
| 12 months | has own jargon, gestures, understands simple phrases like no, bye, bottle |
| 18 months | uses 6 meaningful words |
| 18 months | follows 1 step commands |
| 24 months | 50 word vocab |
| 24 months | uses simple 2 word phrases |
| 24 months | uses negative and possessives |
| 24 months | points to body parts |
| 30-36 months | names pictures |
| 30-36 months | follows 2 step commands |
| 36 months | uses 4 word sentences |
| 36 months | asks questions |
| 36 months | uses past and future tenses |
| 48 months | uses full sentences and has adult grammar |
| 48 months | differentiates and answers simple question |
| rear facing car seat until | 3 yrs |
| booster seat | if after 7 years and still under 4ft 9 in |
| allowed to sit in front of car | 13 yrs |
| 2nd overall cause of unintentional death | drowning |
| drowning | peaks in preschool and ten years |
| infants | drown in bath tubs |
| preschoolers | drown in swimming pools |
| preteens/adolescents | drown in natural bodies of water |
| cause of death due to fire | due to smoke inhalation or asphyxiation |
| suicide | 1 million children come home to a loaded gun unsupervised |
| highest suicide rates race | american indians |
| 1st cause of death in <1yr | inhalation/ aspiration |
| 2nd cause of death in <1 | mechanical suffocation |
| 3rd cause of death in <1 | MVA |
| 1st cause of death in preschool 1-4 | MVA |
| 2nd cause of death in preschool 1-4 | drowning |
| 3rd cause of death in preschool 1-4 | fire and burns |
| 1st cause of death in school age | MVA |
| 2nd cause of death in school age | drowning |
| 3rd cause of death in school age | fire and burns (5-9) |
| 4th cause of death in school age | firearms & homicide (10-14) |
| 1st cause of death in teens | MVA |
| 2nd cause of death in teens | firearms and homicide |
| 3rd cause of death in teens | suicide |
| hot water temp should be | 120 degrees |
| embryonic phase | 8-12 weeks of growth (gestation) |
| fetal phase | last 2 trimesters |
| circulatory development begins | at 4 weeks gestation |
| circulatory development attains final form | at 8-12 weeks gestation |
| 1st blood forming organ | connective tissue (then liver, spleen & bone marrow) |
| Fetal Hb at birth | 80% |
| fetal Hb at 20 weeks old | 5% |
| all primordial upper airway present | 5-6 weeks gestation |
| surfactant production begins | 22-24 weeks gestation |
| lung maturity permits survival | 27-28 weeks |
| bile formation & digestive enzymes | 12 weeks gestation |
| swallowing movements begin | 14 weeks gestation |
| meconium formation seen | 16 weeks gestation |
| weak active sucking & swallowing | 28-29 weeks gestation |
| neural tube development | 4 weeks gestation |
| cerebral hemispheres and ventricle form | 8-12 weeks gestation |
| palms and soles become reflexogenic | 9 weeks gestation |
| fetal movement aware to mom | 13-14 weeks gestation |
| fetal activity decreases & sluggish until birth | 15-16 weeks gestation |
| frontal, temporal, parietal, occipatal lobe development | 16 weeks gestation |
| grasp reflex formed | 17 weeks gestation |
| moro response begins | 25 weeks gestation |
| risk autism | advanced paternal age |
| risk schizophrenia | advanced paternal age |
| risk achondroplasia | advanced paternal age |
| risk neurofibromatosis | advanced paternal age |
| risk marfan syndrome | advance paternal age |
| risk hemophilia A & b | advanced paternal age |
| risk deuschends muscular dystrophy | advanced paternal age |
| risk neural tube defects | obese mother |
| risk ASD, VSD, cardiac abnormalities | obese mother |
| risk cleft lip | obese mother |
| risk anal rectal atresia | obese mother |
| risk limb abnormalities | obese mom |
| risk hydrocephalis | obese mom |
| risk neural tube defects | diabetic mom |
| diabetic mom | inhibits PAX3 gene |
| diabetic mom | large babies |
| risk asthma | AA mom who takes alot of acetaminophen during preg |
| risk ADHD | smoking mom |
| risk ADHD | mercury |
| TORCH | toxoplasmosis, other, rubella, cytomegalovirus, herpes |
| risk of Type II DM & obesity | smoking mom |
| PROM | premature rupture of membranes |
| when is a baby considered infected? | if PROM for >24 hrs |
| C section | if <39 weeks, increase risk of resp distress, infection, neonatal unit admission |
| toxemia | may lead to HTN and proteinuria - at risk for seizures |
| When do you do APGAR score | at 1 min and 5 min after delivery |
| A | appearance |
| p | pulse |
| g | grimace |
| a | activity |
| r | respirations |
| blue pale appearance | 0 |
| body pink extremity blue | 1 |
| all pink appearance | 2 |
| absent pulse | 0 |
| <100 bpm, irreg | 1 |
| >100 | 2 |
| normal HR | 140 |
| no grimace to nasal catheter | 0 |
| grimace to nasal catheter | 1 |
| sneeze to nasal catheter | 2 |
| limp tome | 0 |
| some tome | 1 |
| active motion | 2 |
| absent respirations | 0 |
| slow gasping | 1 |
| good cry | 2 |
| If APGAR almost all 1s, | score is 5 |
| premature | delivered normally |
| premature | develop on time for age |
| small for gest age | never catch up while developing |
| small for gest age | big head |
| risk for small for gest age | HTN mom |
| risk for small for gest age | smoking mom |
| small for gest age | vasoconstriction from old mom with HTN or smoking cause decrease blood flow and decrease nutrition |
| large for gest age | very sick |
| large for gest age | needs to be on monitors, nasal O2 and IV |
| large for gest age | when cord cut, cuts off sugar supply but baby has too much insulin and seizes |
| post mature | decreased subcutaneous tissue, dry baby due to low nutrition due to placenta quitting |
| Skin exam | color, rashes, nevi |
| hemangiomas | most not present at birth |
| sucking baby | eyes open! |
| epicanthal folds | (nasal side) - seen in Downs Syndrome |
| Conjunctivitis on day 1 | m/c cause chemical (due to silver nitrates on skin around eye) |
| conjunctivitis on day 2 | m/c cause gonorrhea |
| conjunctivitis on day 3 or later | due to chlamydia **watch out for pneumonia! |
| Head exam | shape, fontanelles, swelling, lesions, face |
| frontal bossing | prominence of frontal bones seen with congenital syphilis |
| cephalohematoma | blood between the skull and periosteum - at risk for jaundice |
| caput succadeneum | fluid extraperiosteal below scalp and above periosteum |
| unilateral lacrimal duct obstruction | another cause of conjunctivities |
| 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 |
| mouth exam | palate, tongue, ebsteins pearls, supernummerary teeth |
| palate | feel to make sure its intact - may have submucosal cleft |
| submucosal cleft | looks intact but isnt and will create speech problemes |
| high arched palates | associated with developmental and congenital anomalies |
| ebsteins pearls | occlusion cysts midline palate or on gum, look like teeth, benign, rupture and go away |
| supernummerary teeth | babys permanent teeth - no problem |
| neck exam | masses, sinus tracts, clavicles |
| clavicle fractures | many miss this! palpate for crepitus, heal spontaneously |
| masses | SCM lesions, branchial cleft rests; goiter - mom may be hypothyroidism |
| cystic hygroma | seen laterally |
| sinus tracts | remnants of fetal development - dont cause major problems |
| 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! |
| newborn breast engorgement | may leak milk as mom breast feeds - normal due to moms hormones |
| normal resp rate of newborn | 40 |
| tachypnea of newborn | >60 |
| Only congenital anomaly you can rule out with a stethoscope | coarctation of aorta |
| coarctation of aorta | decreased pules in LE femoral pulses |
| Umbilicus vessels | 3 |
| umbilical arteries | 2 |
| umbilical veins | 1 |
| umbilical artery | carries blood to placenta |
| umbilical vein | carries O2 blood to fetus! |
| single umbilical artery | possible malformation in Cardiovascular, CNS, GI, Renal, Karyotypic syndromes |
| Male genital exam | make sure testes are down, look for hydrocele, hernia, hypospadius |
| hypospadius | opening of urethra is any place other than tip; if severe, cant have circumscision because you need the skin to repair it |
| female genital exam | normal to have mucoid or bloody discharge in breast fed babies due to maternal hormones |
| Back exam | look for any skin abnormality overlying the cord because the skin and NS are derived from the same germ layer (neurocutaneous disorders) |
| 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) |
| m/c finding with dysplastic hip | abduction |
| Galazzi sign | knees bent with feet on mattress - is one knee higher than the other? the lower knee is the subluxed hip |
| barlow maneuver | attempt to dislocate the hip - you abduct and push up and feel it slip out the glenoid |
| ortolani sign | when you bring the leg back down and hear the thud when it goes back - relocating the hip |
| developmental dysplasia of hips | evaluate the hips every visit until they walk |
| when will the cord fall off around? | 2-6 weeks |
| 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 |
| baby doesnt cry because has gas | passing gas because right before they cry they take a deep breath in and bear down |
| 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 |
| elevated bili | 1.increased production - due to increased hemolysis 2.impaired handling - due to immaturity or liver disease 3.increased reabsorption from intestine |
| Normal adult Hb | 12-15 |
| 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 |
| septic jaundice | high direct bili |
| polycythemia | due to delayed cord clamping (increases blood volume) can cause jaundice |
| Jaundice of term infants | begins 2-3 days and gone by day 7 |
| premies jaundice | begins day 4-5 and gone by day 14 |
| c-section <38 weeks | increase bili and jaundice because more immature liver |
| when do we worry about bili? | if it rises >7mg/day, >12mg by 48 hrs or >15 by 72 hours |
| Jaundice | starts at head and works down so check soles to see how far along they are |
| kernicteris | yellow staining of brain |
| high direct bili | very bad! |
| high direct bili | caused by sepsis, infection, hemolytic disease, cystic fibrosis |
| Increased indirect bili | most are fine; it is physiologic but look at Coombs test |
| Coombs test | isoimmunization; if positive have Rh or ABO incompatablility |
| ABO incompatability | mom is O because has anti a and anti b and baby is either a or b |
| If coombs was negative | measure Hb next - if Hb high, baby is polycythemic (tomato) |
| causes of high Hb | twin transfusion, maternal-fetal transfusion, delayed cord clamping, small for gest age |
| 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) |
| If reticulcytes high | ask hematologist to look at smear |
| characteristic smear cells | spherocytosis (abnormal, rupture in spleen) |
| how is spherocytosis dx? | family hx of anemia |
| nonspecific smear cells | G6PD deficiency (causing the increased indirect bili) |
| 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 |
| risk for hypoglycemia | small for gest age |
| risk for hypoglycemia | diabetic moms |
| risk for hypoglycemia | premie, postmatures, stressed infants |
| hypoglycemia symptoms | may be asymptomatic |
| lumbar puncture | differentiates between sepsis and meningitis |
| transplacental bacterial infections | syphilis, lyme, TORCH |
| m/c cause of cerebral palsy | maternal infections while preg due to cytokines |
| number 1 etiology of sepsis | group B strep (women are colonized in vag flora) |
| early onset sepsis | types I and II; prevented by IV ABX to mom & screenings |
| late onset sepsis | type III; presents as pneumonia and you die |
| respiratory distress syndrome | most freq cause of resp distress in newborn; results from lack of surfactant |
| xray of respiratory distress syndrome | ground glass appearance |
| tx resp distress syndrome | tx like baby has GroupB strep because the xray looks the same |
| most common pneumonia | Group B strep |
| Crack/cocaine use | 3rd leading cause of birth defects assoc with mental retardation |
| Crack cocaine use clinical findings | microcephaly, short palpebral fissures, flat philtrum, thin vermillian border, migcrognathia, low set ears |
| 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 |
| 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 |
| cows milk based formula brands | enfamil, similac, goodstart |
| cows milk based formula protein source | skim milk (cow) |
| cows milk based formula fat source | soy, coconut, safflower oils |
| cows milk based formula carb source | lactose |
| Lactose | the sugar in breastmilk is lactose so you cant be lactose intolerant at birth |
| 1 kg | 2.2lbs |
| 1 meter | 39.37 in |
| greatest factor correlating with the development of obesity | presence of a TV in a childs bedroom |
| 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 |
Created by:
jjohrden16
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