Pediatric exam <3

What are the components of an APGAR test?

activity, pulse, grimace, appearance (color), and respiration

graded 0-10 (0-3 increased risk of fatality, 9 is most common not 10)

What is the normal temp for a newborn?

36-38C (96.8-100.3F)

What is a normal HR for a newborn?

100-160 bpm

What is a normal RR for a newborn?

30-60 breaths per minute

what is microsomia?

low birth weight

less than 2500 grams

small for gestational age (SGA) vs large gestational age (LGA) vs appropriate for gestational age (AGA)

SGA: <10 percentile

LGA: >90 percentile

AGA: 10-90 percentile

What problems can occur in relation to baby voiding/stooling?

gastrointestinal obstruction, meconium ileus, malrotation/volvulus, Hirschsprung disease, imperforate anus

How do we want the baby’s fontanelles to present?

open, soft, and flat

cephalohematoma vs subgaleal

which one crosses suture lines and which one doesn’t?

crosses suture lines: subgaleal

doesn’t cross: cephalohematoma

What is very important when checking the baby’s eyes?

to assess the red reflex

dark spot or could see a white reflex (leukocoria; retinoblastoma, cataracts, chorioretinitis)

these are remnants of the first brachial cleft and usually have no clinical significance

ear pits and tags

What are babies in relation to their breathing? what is considered apnea and abnormal for babies?

they are obligate nasal breathers

pauses in breathing that are more then 20 seconds is considered apnea and is abnormal

caused by failure of portions of the 1st pharyngeal arch to fuse with the mesenchyme

cleft lip

caused by failure of the palatal shelves to fuse

cleft palate

cleft lip and palate can be associated with ____

trisomy 13

What are two things we are looking at for a newborns neck?

branchial cleft cysts and congenital torticollis

seen mostly in term and post term newborns

they have their first stool in utero and they inhale it

meconium aspiration syndrome

What is the most common cause of tachypnea in term newborns?

transient tachypnea of the newborn

if the femoral pulse cannot be palpated then BP needs to be taken in both arms and one leg to rule out a congenital malformation of the aorta known as _____

coarctation of the aorta

______ is peripheral cyanosis and is a normal newborn finding

acrocyanosis

when is cyanosis not normal in a baby?

transposition of the great vessels

tetrology of fallot

truncus arteriosus

tricuspid atresia

total anomalous pulmonary venous return

What are we looking for when we inspect the umbilical cord?

two thick-walled umbilical arteries and one larger but thin walled umbilical vein

With newborn palpation we should feel ___ and ____ but not ____

liver and spleen but no kidney

presents with feeding problems, emesis, excessive oral secretions and possibly respiratory distress (late sign)

tracheoesophageal fistula

presents with respiratory distress shortly after birth but usually seen on ultrasound in utero

congenital diaphragmatic hernia

double bubble sign

intestinal atresia

intestines protrude through a defect of the abdominal wall with covering

omphalocele

intestines protrude through a defect of the abdominal wall without covering

gastroschisis

condition in which a portion of the bowel becomes necrotic (usually in preterm)

necrotizing enterocolitis

urethral opening on the ventral side of the penis

hypospadius

urethral opening on the dorsal side of the penis

episadias

undescended testes

if left untreated there is an increased risk of testicular cancer

cryptorchidism

when do we get 17OHP level (evaluate for CAH-salt wasting can be life threating), genetic testing, pelvic/abdominal ultrasound, consult genetics and urology

ambiguous genitalia

What should we consider when a baby is missing digits?

amniotic band syndrome

rigid club foot; needs multiple surgeries

congenital talipes equinovarus

bean shaped foot

stiff= concerning

flexible= not concerning

metatarsus adductus

What is Barlow maneuver and what is a positive sign?

push hips back

posterior pressure to abducted thigh then thigh is quickly adducted

positive sign: you feel a clunk as the femoral head dislocates into your hands

What is ortolani maneuver and what is a positive sign?

“out”

abduct thighs while applying anterior pressure to the upper thigh

positive sign: indicates laxity maneuver will reduce the dislocation caused by the Barlow maneuver

When we evaluate a baby’s hips we are checking for _____

what is the treatment?

developmental dysplasia of the hips (DDH)

treat with Pavlik harness (less than 6mo) or spica cast (more then 6mo)

What are the 6 primitive reflexes?

moro: sudden extension of the head causes symmetrical extension then flexion of the arms

grasp: grab object in palm with hand

rooting: head turns when touched near the mouth

asymmetrical tonic reflex: head turned causes elbow to flex on opposite side and to extend on same side

sucking reflex: sucks when nipple/teat placed in mouth

Babinski sign (normal until 12 months)

unconjugated hyperbilirubinemia deposits bilirubin into the basal ganglia, pons, and cerebellum

irreversible

can be fatal

kernicterus

What is slate gray macules patches (mongolian spots) and what is important about them?

pigmented cells in the deep laters of the skin

important to document them to avoid later concerns about bruising or abuse

fine, downy growth of hair over the entire body (premature infants)

lanugo

flat, irregular, light pink patches

nevus simplex

produced by distended capillaries