4: Pediatrics 1

Question 1

What is Normal development: 18 months

Answer 1

• Gross motor
– Walks well alone
– May walk up steps and run

• Fine motor
– Drinks from a cup, feeds
self with spoon
– Can help get undressed

• Social/ emotional 
– Temper tantrums
– Stranger anxiety
– Affectionate towards familiar people
– Points to show others something interesting and to indicate a want

• Language/communication
– Several single words
– “No” andcanshake head

• Cognitive
– Knows what ordinary things are for (phone,
toothbrush, comb)
– Points to one body part
– Scribbles
– Can follow one-step command without gesture

Question 2

What are some considerations you must take when examining an 18 moth old?

Answer 2

• Distraction–Do worst exams @ the end & use distraction.
• Position for comfort
• Leave the most intrusive parts for last
• Be flexible

Question 3

Which of the following are developmental skills did a baby demonstrates? Check all that apply:

A. Follows with eyes
B. Eye contact
C. Cooing
D. Holds head up when on stomach
E. 2 hands together

Answer 3

All of the above

Question 4

How do you know that a baby is healthy?

Answer 4

• Tone/Posture
• Attitude
• Color
• Respiratory rate

Question 5

Describe sick vs well in pediatric patients concerning Color

Answer 5

Sick: Cyanosis, pale, yellow, petechiae, sallow, etc.

Well: Pink

Question 6

Describe sick vs well in pediatric patients concerning Posture

Answer 6

Sick: Limp (floppy), Tripod position, curled on side

Well: Good tone, sitting comfortably

Question 7

Describe sick vs well in pediatric patients concerning Respirations

Answer 7

Sick: Shallow, fast, noisy, slow, retractions, nasal flaring

Well: Normal rate and depth

Question 8

Describe sick vs well in pediatric patients concerning Attitude

Answer 8

Sick: Irritable (crying without consolation)

Well: Consolable

Question 9

See case on pgs. 16 - 24

Answer 9

-

Question 10

PMH in pediatrics includes _______ history.

Answer 10

birth

We want to know if premature or born full-term, jaundice, etc.

Question 11

For immunizations: we want to know if pediatric patient received __,__,__,__ month vaccines.

Answer 11

For immunizations: we want to know if pediatric patient received 2, 4, 6 and 12 month vaccines (start multiplying by 2, four times).

Question 12

What are normal vital signs for children (15 month old)?

Answer 12

• Temp: 38.5 C
• Respirations: 20 - 25 breaths/ min
• BP: 70/50 mmHg
• HR: 100 BPM

Question 13

What is stridor?

Answer 13

Stridor is a high-pitched musical breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. Stridor is a physical sign which is caused by a narrowed or obstructed airway. Stridor is always pathological.

Causes:

• Congenital anomalies
• Trauma (post intubation)
• Foreign body
• Metabolic disorders

• Inflammatory disease
– Retropharyngeal abscess
– Epiglottitis
– Laryngotracheobronchitis

Question 14

What is a steeple sign on x-ray?

Answer 14

In radiology, the steeple sign is a radiologic sign found on a frontal neck radiograph where subglottic tracheal narrowing produces an inverted “V” shape within the trachea itself. The presence of the steeple sign supports a diagnosis of croup.

Question 15

What is Croup?

Answer 15

Croup is inflammation of the subglottic tissues (laryngotracheobronchitis)

It is caused by Parainfluenza virus, influenza, adenovirus, RSV

Peak age of onset is 3 months to 3 years

Clinical features: Prodrome of low-grade fever, rhinorrhea, stridor and hoarse voice

Imaging: Steeple sign on AP neck film

Treatment: Supportive, oxygen/mist, & corticosteroids

Question 16

What is Epiglotitis?

Answer 16

Epiglotitis is inflammation and edema of the epiglottis and aryepiglottic folds

It is caused by Haemophilus influenzae type b, Staph aureus, strep pneumococcus

Peak age of onset is 3- 5 years

Clinical features: Fever, ill or toxic appearance, sore throat, stridor, drooling

Imaging: Thumb print on lateral neck radiograph film

Treatment: Emergent (surgical) airway management, parenteral antibiotics, fluids

Question 17

When examining a pediatric patient, we use the _______ due to the smaller area–localizes sounds better. You can use the _____ for breath sounds.

When examining a pediatric patient, we use take _______ that the infants give us to do other exams–like him waving his arms can do neuro & musculoskeletal exams. ______ exam = doing things @ the best time you can do it.

Answer 17

When examining a pediatric patient, we use the bell or short side of stethoscope due to the smaller area–localizes sounds better. You can use the diaphragm (big part) for breath sounds.

When examining a pediatric patient, we use take opportunities that the infants give us to do other exams–like him waving his arms can do neuro & musculoskeletal exams. Opportunistic exam = doing things @ the best time you can do it.

Question 18

Upper airway sounds = _____

Lower airway sounds = _____

Answer 18

Upper airway sounds = Rochi - mucous plug. Musical sound.

Lower airway sounds = Rales–when you hear sound in lower airway, if you listen over the nose it cant be a rale because over mouth (since lower airway sound)

Question 19

_____ percussion is easier & scratch test for organ sizes is best.

With children of a certain age, you can percuss/ palpate with _______.

Answer 19

Scratch percussion is easier & scratch test for organ sizes is best.

With children of a certain age, you can percuss/ palpate with just one finger.