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Well Child

Info & Q; NP Exam

QuestionAnswer
Babies up to one month of age are called? newborn
Newborn screening includes the following test: 1. PKU 2. Hypothyroidism; T4 3. Hemoglobinopathy-Sickle Cell Anemia
When do we get H&H in newborn? 1. with premature birth 2. critical birth
When are babies expected to "loose" weight? in the first 3-4 days "after" birth; about 10% is acceptable
Rules of Thumb for Weight Gain; 1. Minimally Double weight in first 6 mos 2. Minimally Triple weight in first year
In normal developed term infant, which fontanel is normally open at birth? 1. "A"nterior - "A"lways 2. "P"osterior - "P"eriodically
When does the anterior fontanel close? Anywhere from 9-18 mos.
When do we stop measuring head circumference? At age 3
At birth, how big should the head be? 1-2 cm bigger than the chest
What is Caput succedaneum? tourniquet effect of the cervix; scalp swelling extends across the midline and suture lines; usually resolves over the first few days.
What is Cephalhematoma? hemorrhage between the bone and the periosteum. Because the swelling is "subperiosteal" its boundaries are limited by the ind. bones. Takes weeks to resolve and may be serious
Startle (Moro) Reflex 1. Birth - 4 Mos 2. At loud noise arms spread & fingers extend then clinch fists and arms come toward chest 3. Asymmetry indicates paralysis, fx clavicle; absence indicates brainstem prob; persistence is abnormal
Palmer Grasp Reflex 1. Birth - 3 to 6 Mos 2. When finger is placed in infants hand, infant will flex all fingers around examiners finger 3. grasp should be strong and symmetric
Babinski Reflex 1. Birth - 12 to 24 mos 2. Rub lateral foot up and curve to the toes; extension of toes ok in child but NOT ADULT
Stepping Reflex 1. Birth - 6 to 8 weeks 2. Infant held up with feet on surface, stepping along one foot at a time 3. Absence is paralysis
Rooting Reflex 1. Birth - 3 to 4 mos 2. Head midline, stroke perioral area, infant opens mouth and turns head to stimulated side 3. Absence indicates severe CNS; sleeping infant may not respond
Sucking Reflex 1. Birth - 3 to 4 mos 2. Place nipple or finger 3-4cm in mouth, suck should be strong
Asymmetric tonic neck reflex (ATNR) 1. Birth - 4 to 6 mos 2. With baby supine, rotate head to one side, hold 15 sec, arm & leg extend on facial side; arm & leg on other side flex
Trunk incurvation (galant)reflex 1. Birth - 2 mos 2. Stroke along side of the spine while infant lays on stomach, infant will twitch toward the side of the stimulus
Red Reflex 1. Birth - death bilaterally
What is strabismus and how do we test for it? 1. it is a lazy eye 2. cover/uncover test
What is amblyopia? vision loss
An absence of red reflex might indicate? congenital cataracts
When does vision reach 20/20? 6 years old
At what age is the Snellen Chart appropriate? Age 3-4
Primary dentition: First teeth at what age? Final primary teeth at what age? 1. 6 mos 2. 24 mos
Permanent dentition: First appear at what age? Last teeth at what age? 1. 6-8 years 2. 20 years
What is Torticollis: "wry neck" form of dystonia (prolonged muscle contract) of neck muscles, esp. the sternocleidomastoid, causing head to turn. Important for vision; tort-twist; coll-neck
What is Acrocyanosis? Common & normal for newborn during the first few hours, disappearing over the next day. Due to relatively sluggish circulation of blood through the peripheral structures, related to immaturity or inexperience of the newborn blood flow regulatory system
What is Central Cyanosis? Central cyanosis NOT NORMAL; need for treatment; Accumulation of desaturated (oxygen-depleted) hemoglobin. Cyanosis due to airway obstruction is treated by opening the airway. Cyanosis due to inadequate ventilations is treated by ventilating the baby
At what age does the bilirubin reach its peak? Full term vs Premature Full term 3-4 days Premature 5-7 days
Distinguish direct and indirect bilirubin: indirect is uncongugated bilirubin (not water soluble - it can cross blood brain barrier) direct is conjugated (water soluble ready to be dumped into duodenum)
3 Main classes of hyperbilirubinemia? 1. Physiologic - within first 24 hours - ID causes 2. Breast "Feed" - not enough feedings leads to lack of dump and reabsorption 3. Breast "Milk" - milk intolerance, SE of breast milk
What is aortic coarctation? "constriction" of the aorta usually after the aorta delivers blood to the head and arms and in its descent thus pulse pressure and BP drop in the lower extremities
Normal pulse rate for children: at birth, at 3 years old and 6 years old 1. Birth 120-160 2. 3 years old 80-120 3. 6 years old 70-110
Hispanic 4 year old with umbilical hernia has a homemade umbilical belt to hold hernia in, is this okay? Yes
What is the "evil eye"? look of envy or dislike that inflicts injury or bad luck; cultural phenomena
Do you get circumcision with hypospadias? NO, need the foreskin for repair
3 day old female with blood tinged vaginal discharge, what is it? Normal, moms hormones
How do we assess hydrocele? transillumination; fluid transilluminates
Hydrocele in infants should resolve by when? 12 mos
What to do if you find assymetrical thigh and or gluteal folds? Barlow's and Ortolani's
What is and what to do if find talipes equinovarus? club foot, refer urgently
What is the significance of metatarsus adductus should be able to move feet "back" to midline
Earliest secondary sexual characteristic in girls is what? breast develop (thelarche;T-lark)
Order of maturation for boys is? pubic, axillary, facial hair
Hot watertank should be? less than 120
All sexually active teens should have what? UA dip for chlamydia
Created by: dprest
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