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Dev Dx #2
Dr. Holtzman's 2nd Developmental Dx exam
| Question | Answer |
|---|---|
| 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
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