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Dev Dx #2

Dr. Holtzman's 2nd Developmental Dx exam

What time frame are the terms newborn/neonate, infant and toddler used? Neonate: First 4 weeks; Infant: 1st year of life; Toddler: 1-3 y/o
Describe Erickson's Psychosocial stages. Infancy - basic needs, trust; Toddlers - autonomy; childhood: early - initiative and assertiveness, middle - industry, mastery of tasks; adolescence - identity formation, ethics, morality formation
What does APGAR stand for? Appearance Pulse Grimace Activity Respiration
What does a good score for appearance mean in APGAR? No cyanosis; pink body and extremities
What does a good score for pulse mean in APGAR? >100
What does a good score for gramace mean in APGAR? Cry or withdrawal when stimulated
What does a good score for activity mean in APGAR? Flexed arms and legs that resist extension
What does a good score for respiration mean in APGAR? Strong, lusty cry
What could cause a headache in an infant? Eyesight, tumors, lesions, allergies, ear infxns
What are hearing tests used for infants? Auditory brainstem response where electrodes record electrical activity from acoustic nerve; Otoacoustic emission that measures response produced by cochlea
What are risk factors for hearing impairment? Low APGAR score (<6); birth anoxia; intrauterine infxn w/ rubella or CMV; neonatal meningitis; cranial-facial abnormalities
When is fever an emergency in infants? Any one time over 104F and lasts over 24 hours or remits and returns
Why should you not give children and adolescents ASA? Could lead to Reyes Syndrome
What is Reyes syndrome? Acute encephalopathy and fatty infiltration of viscera secondary to ASA use in children and adolescents w/ viral infxns.
How much should a baby grow in the first year? 1" per month in first 6 mos; after 2 y/o should grow 2" per year; Wt should double in 4 months and gain a pound per month from 6-12 mos
When do the posterior and anterior fontanelles close? Posterior closes around 2 mos; Anterior closes around 7-19 mos
What do bulging or sunken fontanelles mean? Bulging = hydrocephalus/increased intracranial pressure; sunken = dehydration
What is cradle cap? Seborrheic dermatitis, scalp lesions tend to be greasy, yellow and scaly
What are pediculosis capitis? head lice
What are normal ranges of BP for newborns and teens? Newborn-1st year = 85/55 to 100/68; Late teens = 100/65 to 120/70
What could cause secondary HTN in children? Renal a. stenosis, glomerulonephritis, agenesis of a kidney, polycystic kidneys, phelochromocytoma, any kidney disease
What is acrocyanosis? Blue hands and feet, seen from birth to 3 days old
What is lanugo? Fine downy hair, seen from birth to 2 weeks old; normal in child, in adults seen on anorexics
What is physiological jaundice? Shows up 2-3 days after birth in up to 65%; usually treated w/ UV light now
What causes abnormal jaundice? Rh incompatibilities, enzyme defects, hemoglobinopathies; HbF transitions into adult Hb in first 6 mos; Could be caused by unconjugated bilirubin from blocked bile ducts or hemolysis of RBCs
What is Milia? Appears from birth - 3 weeks old in ~40% of infants; Small white papules on cheek, nose and chin
What is teliangectatic nevus? AKA stork bite/angel kiss; 1-2 superficial, vascular red patches on face and neck/head; benign
What is strawberry hemangioma? Develop shortly after birth, benign, starts flat then raises and involute by end of 1st year; gone by 5-7 y/o
What is a port wine stain? Flat hemangioma present at birth, usually appear on one side of face or extremity; permanent lesion
What if a port wine stain has the 1st branch of the trigeminal involved? Can be Sturge-Weber syndrome; rare causes seizurese
What can infantile atopic dermatitis (eczema) cause? 30-50% develop asthma or allergic rhinitis
What is and causes impetigo? Highly contagious skin erosion covered w/ honey-colored crust; d/t staph or group A strep
What childhood illness can be a risk to the mother if she is in the first trimester of a pregnancy? German measles/rubella - dangerous to fetus
What are the major criteria in Jones criteria for scarlet fever? Carditis (MVP); polyarthritis; sydenham's chorea; erythema marginatum; subcutaneous nodules
What is the most common small vessel vasculitis in kids? henoch-shonlein purpura AKA anaphylactic purpura - follows strep infection
What is setting-sun sign? Retraction of upper lid w/o upward gaze (1/2 pupil below lower lid)
What are brushfield's spots? Speckled areas in the periphery of the iris
What are possible cardiac red flags in infants? Chronic early difficulties in feeding and or excessive perspiration; Cyanosis if just LE PDA or COA
What is rooting reflex? Stroke the peri-oral area and head should turn toward the stimulus; gone by 3-4 mos old
What is the moro reflex? Loud noise or loss of support should give abduction/extension of UE's/trunk followed by return to flexion; integrated by 6 mos; if absent UMNL; if asymmetric brachial plexus problem
What is the Galant reflex? Stroke paravertebral muscles from thoracics to sacrum and should laterally flex to side of stimulus; integrated by 2-6 mos
What is the Plantar reflex in newborns? Same stimulus, response is flaring of toes and dorsiflexion of great toe, integrated by 2 y/o
What is the fencer reflex? Passive rotation of the head; response is extension of extremities to side turn head, relative flexion to opposite side
What is the positive support reflex? Bouncing feet on firm surface, neonate response is LE extension then flexion gone by 2-3 mos old; mature response is extension followed by support of body weight in >6 month old
What is the stepping reflex? Pressure on sole of foot while vertical; response is stepping gait; integrated by 2-3 mos old
What is the placing reflex? Stroking dorsum of foot or hand on undersurface of table; response is extremity is flexed and put on top of the stimulus
What is the Landau reflex? Infant held in horizontal position and infant will lift head and extend neck and trunk and LE; Present by ~6mos; If neck is passively flexed whole body will flex
What is the righting reflex? Head turned to 1 side, body rolls toward that side; appears at 3 mos
When do anterior propping, lateral propping, posterior propping and parachute appear? Anterior: 4-5 mos; Lateral: 6-7 mos; Posterior: 8-10 mos; Parachute: ~8 mos
What are the 3 stages of the pull-to-sit response? Sit upright w/ minimal support; Able to prop self up w/ arms (6 mos); Can maneuver out of sitting position w/o assistance
What is the parachute response? Suspend baby by trunk and suddenly lower as if child falling for an instant should spontaneously throw out arms
What are the 6 major gross motor milestones? Dev head control at 3 mos; masters rolling at 4 mos; learns to sit at 6 mos; begins crawling at 7-11 mos; stands alone for short periods at 13 mos; starts walking 13-15 mos
What are s/s of meningitis in children? High-pitched crying, whimpering; dislike of being touched; arching neck and back; lethargic, fever, listless; pale blotchy skin color; refuses feeding &/or vomiting
What is a seizure? Abnormal electrical discharge
What is a partial seizure? Simple or complex; both have a focal onset in the brain
What is a generalized seizure? Absence; myoclonic; tonic-clonic; all have a generalized onset in the brain
Describe a complex partial seizure. Temporal lobe epilepsy: consciousness impaired starts as partial w/ or w/o automatisms, usually well-defined aura, if impaired consciousness at the onset can progress to generalized
Describe an absence generalized seizure. Briefly unaware ~30s; can be misdiagnosed as ADHD
Describe a myoclonic generalized seizure. Brief repetitive symmetric muscle contractions or loss of tone; regain consciousness quickly
Describe a tonic-clonic seizure. Rhythmic jerking w/ flexor spasms or sustained muscle contraction or both
What is status epilepticus? Either >30 min of continuous seizure activity or 2 or more sequential seizures over the course of 30 min w/o full recovery b/w each; This is an emergency cond'n!!
What is the most common permanent disability in children? Cerebral palsy; thought to originate from cerebral insult or injury - anoxia #1 mechanism
What is Erb's palsy? [C5-6]Most common dystocia; arm held in addx, IR and pronation w/ wrist and fingers flexed; biceps reflex absent, palmar grasp present, moro will see hand move but no shoulder mvmt
What is Klumpke's palsy? Hand held in claw; [C8-T1]
What is the normal progression of leg alignment? Newborn: genu varum; 1.5-2 y/o legs straight; 2.5 y/o genu valgum; 4-6 y/o legs straight
What is metatarsus adductus? Pigeon toed; forefoot adducted, not the heel (club foot includes heel)
What is Blount's Dz? Tibial vera; tibia growth disorder where medial tibial growth plate fails to develop and tibia bows inward
What is piston mobility? AKA telescoping sign; grasp distal thigh and knee in one hand. Hold greater trochanter w/ other. Move femur up and down; increased motion or unsmooth motion + for hip dysplasia
What is ortolani's maneuver? flex hip to 90 then abd while lifting up on greater trochanter; should feel reduction or hear a click + for hip dysplasia
What is torticollis? Unilateral spasm of SCM d/t birth trauma, spinal cord tumor, congenital spinal anomalies, atlanto-axial rotary subluxation
What are complications of SCFE? aVN; Legg-Calve-Perthes Dz = infarction of bony epiphysis of femoral head secondary to insufficient blood supply; usually affects children 5-10 y/o; smoking during pregnancy can be a cause
Where are growing pains normally felt? In muscle groups and moves to different muscle groups; no joint involvement or limping; typically bilateral and symmetrical; pain worse in late day and night
In JRA what defines pauciarticular and polyarticular? Pauciarticular: <4 (wb) joints common complaints w/ eyes; Polyarticular: >5 joints w/ some systemic signs and a bimodal onset
What is systemic JRA? Stills Dz; Daily fevers w/ spikes; macular rash and visceral problems w/ LV and SP enlargement and lymphadenopathy and leukocytosis
What weight of backpacks can cause compensatory forward head posture? 10-15% of body weight
What is reverse fencer? <6 mos hold child upside down and let go of 1 leg and head turns to that side and repeat on other side; whatever side the head does not turn to is side of subluxation
What do you do w/ the acetabular pump in reverse fencer? Hlding knee, press I-S, A-P into acetabulum on each side, if sublux side is as strong as good side - occiput if sublux side is weak - atlas
Created by: kabrown