NR 602 Mid-term
Infant development - Answer -1m: dolls eyes, nose breathing, hands closed, sees 20-
25cm away, sleeps 16-17 hrs a day
-2m: post fontanel closes, decr head lag, coos,follows toy side to side, sleeps
8.5-10rs/night & 6-7 hrs day
-3m: all primitive reflexes fading, holds head, bears weight on legs, does not reach for
rattle, babbling, mirrors, recognizes familiar objects and faces, sleeps 15-16 hours per
day.
Infant development - Answer -4m: drooling, no morrow/tonic neck, sits if propped, plays
with hands, pulls on things, shows mood, laughs, focus on things 1/2in from face,
regular sleep/wake pattern
- 5m: double birth wt, rolls back to belly, pull objects to mouth, follows dropped object,
sleeps 10-11 hrs & 3 naps.
- 6m: growth slows (3-5oz/week, 1/2in/month), rolls back to belly, sits in chair with back,
recognize parent, definite likes/dislikes, 13-14 hours sleep, 2-3 naps.
- 7m: leans to tripod position, bounce when standing, bang objects, 4 vowels said,
knows name, stranger anxiety
Infant Development - Answer -8m: regular b/b pattern, sits unsupported, pincer grasp,
knows "no", more stranger anxiety, sleeps 11-12hrs + 2-3 naps
- 9m: refined pincer grasp, steadily sits unsupported, pulls to stand, wants to please
parents, 2 naps
-10m: mature pincer,walks holding on, grabs by the handle, "mama/dada", object
permanence, 2 naps
-11m: lower lat incisors, pivots when standing, imitates sounds, rolls ball when asked
-12m: triples birth wt, length by 50%, walks holding 1 hand, 5-7 words, security object
Tanner (pubic hair) - Answer 1) no pubic hair
2) initial, scarce pigmented hair along medial border of labia
3) sparse, dark, visibly pigmented curly hair on labia
4) hair coarse and curly, abundant but less than adult
5) lateral spreading, triangle spread of adult hair to medial surface of thighs
Tanner (Males) - Answer 1) Prepubertal
2) enlargement of scrotum & testes & change in scrotum texture. May be reddened
3) further penile growth (length first) & testes & scrotum
4) significantly enlarged ion length & circumference penis. more development of glans
penis. darkening of scrotal skin (facial hair after this only)
5) adult genitals
Tanner (Breasts) - Answer 1) prepubertal
2) Breast buds palpable under areola, enlargement of areola
3) breast tissue palpable outside areola- no areolar development or separation of
contour
4) Areola elevated above contour of breast forming "double scoop" appearance
, NR 602 Mid-term
5) Areola mound recedes back into single breast contour with areolar
hyperpigmentation, papillae development/ projection & nipple protrusion
chalazion - Answer -chronic sterile inflammation of eyelid from a lipogranuloma of the
meibomian gland
- initially, mild redness & swelling, then after a few days, a slow-growing, round,
nonpigmented PAINLESS mass remains.
- Acute tx: hot compress, refer to eye MD
Blepharitis - Answer - acute or chronic bacterial (staph) inflammation of eyelash follicle
or sebaceous gland of eyelid. bilateral usually
-flaky, scaly debris over eyelid margin when awakening
- tx: warm compress, scrub with weak shampoo, sometimes bacitracin or erythromycin,
-no contacts during tx
Otitis Media - Answer - bulging TM, ear pain, , ETD, fever,irritability, otorrhea, absent
TM mobility
-RSV/influenza most common viruses
- s.pneumonia, haemophilus, strep (bacteria)
- Tx: Amoxicillin (1st time), Amox/clavu (when AOM within 30 days), ceftriaxone, azith
(penicillin allergy)
- <2: treat 10 days, >2, 5-7 days
- ofloxacin or cipro gtts is TM perforated, or draining PE tubes
Otitis Externa (Swimmer's Ear) - Answer - swelling of EAC and pinna/TM
- sx: itching, irritation, pain, pressure in eat, conductive or SNHL, pain with tragus or
pinna movement, maybe lymphadenopathy, red, crusting lesions, dry canal,
-tx: DROPS- ciprodex, vasocidin (ok if rupture tm). cortisporin, cipro HC (TM intact),
domeboro (cleaning only)
Conjunctivitis - Answer -most common peds infection, yellow-green purulent discharge,
matted eyes when waking, itching
-bacterial (unilateral), viral (bilateral)
- usually self-limiting, but may treat with atbx
- tx: sodium sulfacetamide or tmp+polymycin B, or erythromycin, azith (>12m), -
floxacins (>12m). no -mycins)
-newborn: chlamydia trach. (erythromycin PO), gonorrhea (ceftriaxone IM/IV). DFA
conjunctival test
-
Milia - Answer - pearly, white papules over forehead, nose, and cheeks.
- no tx
salmon patch - Answer - flat lesion or vascular malformation on back of neck, upper
eyelids and glabella
- 60-70% of newborns have on back of neck
