Bates CHARTS Flashcards
is the most common dysrhythmia in children.
Some infants with this look well or may be somewhat pale with tachypnea, but have a heart rate of ≥240 beats per minute. Others are ill and in cardiovascular collapse. P waves have different morphology or are not seen.
Paroxysmal supraventricular tachycardia (SVT)
SVT in infants is usually sustained, requiring medical therapy for conversion to a normal rate and rhythm.
In older children, it is more likely to be truly ___________, with episodes of varying duration and frequency.
paroxysmal
Hypertension can start in childhood.
Although elevated blood pressure in young children is more likely to have a ___,_____, or _____,
renal, cardiac, or endocrine cause
older children and adolescents with hypertension are most likely to have ______ or _________
primary or essential hypertension.
This child developed hypertension, and it “tracked” into adulthood.
Children tend to remain in the same percentile for blood pressure as they grow.
This tracking of blood pressure continues into adulthood, supporting the concept that ______ _______ _______ often begins during childhood.
The consequences of untreated hypertension can be severe.
adult essential hypertension
These common yellow or white pustules are surrounded by a red base.
Erythema Toxicum
Red pustules and papules are most prominent over the cheeks and nose of some normal newborns.
Neonatal Acne
The salmon red, scaly eruption often involves the face, neck, axilla, diaper area, and behind the ears.
Seborrhea
Erythema, scaling, dry skin, and intense itching characterize this condition.
Atopic Dermatitis (Eczema)
Characteristic features include more than 5 café-au-lait spots and axillary freckling. Later findings include neurofibromas and Lish nodules (not shown).
Neurofibromatosis
This bright red rash involves the intertriginous folds, with small “satellite lesions” along the edges.
Candidal Diaper Dermatitis
This irritant rash is secondary to diarrhea or irritation and is noted along contact areas (here, the area touching the diaper).
Contact Diaper Dermatitis
This infection is due to bacteria and can appear bullous or crusty and yellowed with some pus.
Impetigo
Dry, rough warts on hands
Verruca Vulgaris
Small, flat warts
Verruca Plana
Tender warts on feet
Plantar Warts
Dome-shaped, fleshy lesions
Molluscum Contagiosum
involves open comedones (blackheads) and closed comedones (whiteheads) shown at the left, and inflamed pustules (right).
Adolescent Acne
Intensely pruritic, red, distinct papules characterize these lesions.
Bites
Scaling, crusting, and hair loss are seen in the scalp, along with a painful plaque (kerion) and occipital lymph node (arrow).
Tinea Capitis
This pruritic, allergic sensitivity reaction changes shape quickly.
Urticaria (Hives)
Intensely itchy papules and vesicles, sometimes burrows, most often on extremities
Scabies
This annular lesion has central clearing and papules along the border.
Tinea Corporis
Oval lesions on trunk, in older children, sometimes a herald patch
Pityriasis rosea
Although not present at birth, it appears within the first 24 hours from subperiosteal hemorrhage involving the outer table of one of the cranial bones.
The swelling, shown at the arrow, does not extend across a suture, though it is occasionally bilateral following a difficult birth.
The swelling is initially soft, then develops a raised bony margin within a few days from calcium deposits at the edge of the periosteum. It tends to resolve within several weeks.
Cephalohematoma
the anterior fontanelle is bulging, and the eyes may be deviated downward, revealing the upper scleras and creating the setting sun sign, as shown on the left. The setting sun sign is also seen briefly in some normal newborns.
Hydrocephalus
is a condition of premature closure of one or more sutures of the skull. This results in an abnormal growth and shape of the skull because growth will occur across sutures that are not affected but not across sutures that are affected.
The figures demonstrate different skull shapes associated with the various types of this.
The prematurely closed suture line is noted by the absence of a suture line in each figure.
Scaphocephaly and frontal plagiocephaly are most common.
The blue shading shows areas of maximal flattening. The red arrows show the direction of continued growth across the sutures, which is normal.
Craniosynostosis
Babies born to women with chronic alcoholism are at increased risk for growth deficiency, microcephaly, and mental retardation.
Facial characteristics include short palpebral fissures, a wide and flattened philtrum (the vertical groove in the midline of the upper lip), and thin lips.
Fetal Alcohol Syndrome
The child has coarse facial features, a low-set hair line, sparse eyebrows, and an enlarged tongue.
Associated features include a hoarse cry, umbilical hernia, dry and cold extremities, myxedema, mottled skin, and mental retardation.
Most infants with this have no physical stigmata; this has led to screening of all newborns in the United States and most other developed countries
congenital hypothyroidism (cretinism)
In utero infection by Treponema pallidum usually occurs after the 16th week of gestation and affects virtually all fetal organs.
If it is not treated, 25% of infected babies die before birth and another 30% shortly thereafter.
Signs of illness appear in survivors within the first month of life.
Facial stigmata shown here include bulging of the frontal bones and nasal bridge depression (saddle nose), both from periostitis; rhinitis from weeping nasal mucosal lesions (snuffles); and a circumoral rash.
Mucocutaneous inflammation and fissuring of the mouth and lips (rhagades), not shown here, may also occur as stigmata, as may craniotabes tibial periostitis (saber shins) and dental dysplasia (Hutchinson’s teeth
congenital syphilis
may be from
(1) an injury to the nerve from pressure during labor and birth,
(2) inflammation of the middle ear branch of the nerve during episodes of acute or chronic otitis media, or
(3) unknown causes (Bell’s palsy).
The nasolabial fold on the affected left side is flattened, and the eye does not close.
This is accentuated during crying, as shown here.
Full recovery occurs in ≥90% of those affected.
Facial Nerve Palsy
Peripheral (lower motor neuron) paralysis of the facial nerve
usually has a small, rounded head, a flattened nasal bridge, oblique palpebral fissures, prominent epicanthal folds, small, low-set, shell-like ears, and a relatively large tongue.
Associated features include generalized hypotonia, transverse palmar creases (simian lines), shortening and incurving of the fifth fingers (clinodactyly), Brushfield’s spots, and mental retardation.
Down syndrome (trisomy 21)
The child may have old and fresh bruises on the head and face and may either look sad and forlorn or be actively seeking to please, sometimes even particularly involved with and attentive to the abusing parent.
Other stigmata include bruises in areas (axilla and groin) not usually subject to injury rather than the bony prominences;
x-ray evidence of fractures of the skull, ribs, and long bones in various stages of healing; and skin lesions that are morphologically similar to implements used to inflict trauma (hand, belt buckle, strap, rope, coat hanger, or lighted cigarette).
Battered Child Syndrome
The child has an open mouth (cannot breathe through the nose) and edema and discoloration of the lower orbitopalpebral grooves (“allergic shiners”).
Such a child is often seen to push the nose upward and backward with a hand (“allergic salute”) and to grimace (wrinkle the nose and mouth) to relieve nasal itching and obstruction.
Perennial Allergic Rhinitis
occurs in approximately 2 per 1,000 children younger than 10 years.
Affected children exhibit hypermetabolism and accelerated linear growth.
Facial characteristics shown in this 6-year-old girl are “staring” eyes (not true exophthalmos, which is rare in children) and an enlarged thyroid gland (goiter).
Hyperthyroidism
Thyrotoxicosis (Graves’ disease)
These abnormal speckling spots on the iris suggest Down syndrome.
Brushfield’s Spots
Strabismus, or misalignment of the eyes, can lead to visual impairment. Esotropia, shown here, is an inward deviation.
Strabismus
is one of the most common conditions in young children.
The spectrum is shown here.
what are A, B and C showing
Otitis Media
(A) Typical acute otitis media with a red, distorted, bulging tympanic membrane in a highly symptomatic child.
(B) Acute otitis media with bullae formation and fluid visible behind the tympanic membrane.
(C) Otitis media with effusion, showing a yellowish fluid behind a retracted and thickened tympanic membrane.
This infection is common in infants. The white plaques do not rub off.
Oral Candidiasis (“Thrush”)
Tender ulcerations on the oral mucosa are surrounded by erythema.
Herpetic Stomatitis
whats going on here?
Nursing Bottle caries
what is going on here?
erosion of teeth
is is a major global health and pediatric problem. The photographs to the left show different characteristics of caries.
Dental Caries
This common childhood infection has a classic presentation of erythema of the posterior pharynx and palatal petechiae (left). A foul-smelling exudate (right) is also commonly noted.
Streptococcal Pharyngitis (“Strep Throat”)
Enlarged and tender cervical lymph nodes are common in children. The most likely causes are viral and bacterial infections. Lymph node enlargement can be bilateral, as shown in the figure to the left.
Lymphadenopathy
It is important to recognize cyanosis. The best location to examine is the ____________.
mucous membranes
Cyanosis is a “_______” color, whereas normal mucous membranes should have a “________” color.
Cyanosis is a “raspberry” color, whereas normal mucous membranes should have a “strawberry” color.
This baby has total anomalous pulmonary venous return and an oxygen saturation level of 80%.
Generalized Cyanosis
This baby has mild cyanosis above the lips, but the mucous membranes remain pink.
Perioral Cyanosis
Normal pigment deposition in the vermilion border of the lips gives them a bluish hue, but the mucous membranes are pink.
Bluish Lips, Giving Appearance of Cyanosis
This commonly appears on the feet and hands of babies shortly after birth. This infant is a 32-week-old newborn.
Acrocyanosis
Some heart murmurs reflect ____________. If you understand their physiologic causes, you will more readily be able to identify and distinguish them from ______ ________ _________.
underlying heart disease
innocent heart murmurs.
_________ ________ result when blood flows through valves that are too small. Because this problem does not depend on the drop in pulmonary vascular resistance following birth, these murmurs are audible at birth
Obstructive lesions
Defects with left-to-right shunts, on the other hand, depend on the drop in ______ _________ ________.
pulmonary vascular resistance
_____-______ _______ such as ventricular septal defect, patent ductus arteriosus, and persistent truncus arteriosus are not heard until 1 week or more after birth.
High-pressured shunts
_____-_______ left-to-right shunts, such as in atrial septal defects, may not be heard for considerably longer, usually first being noted at 1 year or more.
low -pressured
Usually a normal valve anulus with fusion of some or most of the valve leaflets, restricting flow across the valve
Pulmonary Valve Stenosis
Location. Upper left sternal border
Radiation. In mild degrees of stenosis, the murmur may be heard over the course of the pulmonary arteries in the lung fields.
Intensity. Increases in intensity and duration as the degree of obstruction increases
Quality. Ejection, peaking later in systole as the obstruction increases
Pulmonary Valve Stenosis
Usually a prominent ejection click in early systole
Pulmonary component of the second sounds at the base (P2) becomes delayed and softer, disappearing as obstruction increases. Inspiration may increase murmur; expiration may increase click.
Growth is usually normal.
Newborns with severe stenosis may be cyanotic from right-to-left atrial shunting and rapidly develop heart failure.
Pulmonary Valve Stenosis
Usually a bicuspid valve with progressive obstruction, but there may be a dysplastic valve or damage from rheumatic fever or degenerative disease
Aortic Valve Stenosis
Location. Midsternum, upper right sternal border
Radiation. To the carotid arteries and suprasternal notch; may also be a thrill
Intensity. Varies, louder with increasingly severe obstruction
Quality. An ejection, often harsh, systolic murmur
Aortic Valve Stenosis
May be an associated ejection click
The aortic closure sound may be increased in intensity. There may be a diastolic murmur of aortic valve regurgitation.
Newborns with severe stenosis may have weak or absent pulses and severe heart failure. May not be audible until adulthood even though the valve is congenitally abnormal
Aortic Valve Stenosis
Complex defect with ventricular septal defect, infundibular and usually valvular right ventricular outflow obstruction, malrotation of the aorta, and right-to-left shunting at ventricular septal level
With Pulmonic Stenosis
Tetralogy of Fallot
General. Variable cyanosis, increasing with activity
Location. Mid-to-upper left sternal border. If pulmonary atresia, there is no systolic murmur but the continuous murmur of ductus arteriosus flow at upper left sternal border or in the back.
Radiation. Little, to upper left sternal border, occasionally to lung fields
Intensity. Usually grade III–IV
Quality. Midpeaking, systolic ejection murmur
Teralogy of Fallot
Normal pulses
The pulmonary closure sound is usually not heard.
May have abrupt hypercyanotic spells with sudden increase in cyanosis, air hunger, altered level of awareness
Failure to gain weight with persistent and increasingly severe cyanosis
Long-term persistence of cyanosis accompanied by clubbing of fingers and toes
Persistent hypoxemia leads to polycythemia, which will accentuate the cyanosis.
Tetralogy of Fallot
A severe defect with failure of rotation of the great vessels, leaving the aorta to arise from the right ventricle and the pulmonary artery from the left ventricle
Transposition of the Great Arteries
General. Intense generalized cyanosis
Location. No characteristic murmur. If present, it may reflect an associated defect such as VSD.
Radiation and Quality.Depends on associated abnormalities
Transposition of the Great Arteries
Single loud second sound of the anterior aortic valve
Frequent rapid development of heart failure
Frequent associated defects, as described at the left
Transposition of the Great Arteries
Blood going from a high-pressured left ventricle through a defect in the septum to the lower-pressured right ventricle creates turbulence, usually throughout systole.
Small to Moderate
Ventricular Septal Defect
Location. Lower left sternal border
Radiation. Little
Intensity. Variable, only partially determined by the size of the shunt. Small shunts with a high pressure gradient may have very loud murmurs.
Large defects with elevated pulmonary vascular resistance may have no murmur. Grade II–IV/VI with a thrill if grade IV/VI or higher.
Quality. Pansystolic, usually harsh, may obscure S1 and S2 if loud enough
Ventricular Septal Defect
With large shunts, there may be a low-pitched middiastolic murmur of relative mitral stenosis at the apex.
As pulmonary artery pressure increases, the pulmonic component of the second sounds at the base increases in intensity.
When pulmonary artery pressure equals aortic pressure, there may be no murmur, and P2 will be very loud.
‘
In low-volume shunts, growth is normal.
In larger shunts, heart failure may occur by 6–8 weeks; poor weight gain.
Associated defects are frequent.
Ventricular Septal Defect
Continuous flow from aorta to pulmonary artery throughout the cardiac cycle when ductus arteriosus does not close after birth
Small to Moderate
Patent Ductus Arteriosus
Location. Upper left sternal border and to left
Radiation. Sometimes to the back
Intensity. Varies depending on size of the shunt, usually grade II–III/VI.
Quality. A rather hollow, sometimes machinery-like murmur that is continuous throughout the cardiac cycle, although occasionally almost inaudible in late diastole, uninterrupted by the heart sounds, louder in systole
Patent Ductus Arteriosus
- Full to bounding pulses
- Noticed at birth in the premature infant who may have bounding pulses, a hyperdynamic precordium, and an atypical murmur
- Noticed later in the full-term infant as pulmonary vascular resistance falls
- May develop heart failure at 4–6 weeks if large shunt
- Poor weight gain related to size of shunt
- Pulmonary hypertension affects murmur as above.
Patent Ductus Arteriosus
Left-to-right shunt through an opening in the atrial septum, possible at various levels
Atrial Septal Defect
Location. Upper left sternal border
Radiation. To the back
Intensity. Variable, usually grade II–III/VI
Quality. Ejection but without the harsh quality
Atrial Septal Defect
Widely split second sounds throughout all phases of respiration, normal intensity
Usually not heard until after age of 1 year
Gradual decrease in weight gain as shunt increases
Decreased exercise tolerance, subtle, not dramatic
Heart failure is rare.
Atrial Septal Defect
- Marked and immediate dilatation of the anus in knee–chest position, with no constipation, stool in the vault, or neurologic disorders
- Hymenal notch or cleft that extends >50% of the inferior hymenal rim (confirmed in knee–chest position)
- Condyloma acuminata in a child older than 3 years
- Bruising, abrasions, lacerations, or bite marks of labia or perihymenal tissue
- Herpes of the anogenital area beyond the neonatal period
- Purulent or malodorous vaginal discharge in a young girl (culture and view all discharges under a microscope for evidence of a sexually transmitted infection)
Physical Signs of Sexual Abuse
Possible Indications
- Lacerations, ecchymoses, and newly healed scars of the hymen or the posterior fourchette
- No hymenal tissue from 3 to 9 o’clock (confirmed in various positions)
- Healed hymenal transections, especially between 3 and 9 o’clock (complete cleft)
- Perianal lacerations extending to external sphincter
Physical Signs of Sexual Abuse
Strong Indications
A child with concerning physical signs must be evaluated by a _____ ______ _______ for a complete history and sexual abuse examination.
Any physical sign must be evaluated in light of the entire history, other parts of the physical examination, and laboratory data.
sexual abuse expert
okay guys warning… im sorry these next 6 cards are a little graphic and sad….. they are however in one of the tables in bates so I included them here
<3
Acute hemorrhage and ecchymoses of tissues (10-month-old)
Erythema and superficial abrasions to the labia minora (5-year-old)
Healed interruption of hymenal membrane at 9 o’clock (4-year-old)
Narrowed posterior ring continuous with floor of vagina (12-year-old)
Copious vaginal discharge and erythema (9-year-old)
Extensive condylomata around the anus (2-year-old)
is the most common congenital penile abnormality.
The urethral meatus opens abnormally on the ventral surface of the penis.
One form is shown above; more severe forms involve openings on the lower shaft or scrotum.
Hypospadias
You should distinguish between ______ ______, shown above (with testes in the inguinal canals—see arrows), from highly retractile testes from an active cremasteric reflex.
Undescended Testicle
from laxity of the soft-tissue structures of the foot
Flat feet or pes planus
_______ of the foot (_____)
Inversion
(varus)
The forefoot is adducted and not inverted.
Metatarsus adductus in a child.
What is this a picture of??
(A) When viewed from behind, the hindfoot is everted. (B) When viewed from the front, the forefoot is everted and abducted.
Pronation in a toddler.
what has been named the single most important medical intervention in the world in terms of influence on public health.
Childhood vaccines
which vaccine-preventable disease is shown
Polio
The deformed leg of this child is from polio.
which vaccine-preventable disease is shown
Measles
Characteristic rash of measles
which vaccine-preventable disease is shown
Rubella
Rubella rash on a child’s back
which vaccine-preventable disease is shown
Tetanus
Rigid newborn with neonatal tetanus
which vaccine-preventable disease is shown
Haemophilus influenzae
Type b
Periorbital cellulitis from this invasive bacterial disease
which vaccine-preventable disease is shown
Varicella
An infant with a severe form of varicella
which vaccine-preventable disease is shown
Meningitis
which vaccine-preventable disease is shown
Pertussis
which vaccine-preventable disease is shown
Cervical Cancer
Largely prevented through vaccination by human papillomavirus vaccine.
