Day 4 Clinical Examination Flashcards
HELP- whats it stand for
Hello: intro, consent
Engage: stethoscope, make a game, mobiles, books, toys
L: get down to their level
P:atter: don’t stay silent, explain & compliment
Where to examine
infant
toddler
child
infant: cot
toddler: on parents lap
child: bed
Peripheral CPR ↑
What to do
normal, early sign of shock
Test central
On the PAWS chart why does a child only score of temp at 39?
Children have more fevers (viral infections)
Temperature can be higher than in adults
clubbing
hypoxia
chronic anaemia
malignancies
What is ‘normal’ BP estimate dependant on?
- Age
- Height
Paediatric bp charts
Signs infective endocarditis
- Janeaway lesions
- Osler nodes
Where best to feel for pulse
- newborn
- baby
- femoral (coarctation of aorta)
- ## brachial
Where best to feel for pulse
- newborn
- baby
- older
- femoral (coarctation of aorta)
- brachial
- carotid
Auscultation
what are you listening for?
- Lungs bases (pulmonary oedema)
Murmurs
- Site
- systolic/diastolic
- grade /intensity
- pitch (high/low)
- radiation
- change with inspiration/posture
Descibe murmurs you can hear in aortic (UR), pulmonary (UL), Tricuspid (LR) and Mitral (LL)
A
- Aortic stenosis
P
- Pulmonary flow mumor
- Pulmonary stenosis
- PDA (Patent ductus arteriosis)
- ASD (atrial septic defect, downs)
T
- VSD
- Aortic regurgitation
- Still’s (innocent flow murmur)
- tricuspid regurg (rare)
M
- Mitral regurgitation (rare)
- Mitral stenosis (rare)
Grade 4 murmur
Got a thrill
Respiratory exam:
what causes grunt
preventing ↓ pressure on expiration, compensation for resp distress seen in early life.
PEP
Stridor & tracheal tug & abdominal rising
upper airway obstruction
- croup (viral)
- epiglottitis
- Severe tonsillitis
- congenital
Seesaw breathing
Intercostal reccession
Severe asthma?
Difference between stridor & grunting
stridor: inspiratory
grunting: expiraptory
Head bopping
young baby
Open airway
chest is moving so much
Wheeze
- Expiratory or inspirtory
Expiratory: smaller airway obstruction
asthma: bronchiolitis
Inspiratory: stridor
Upper airway.
What is harrison sulci
subcostal recession
chronic lung disease (prematurity, bronchiolitis)
Signs of respiratory distress
Babys
Babys: head bopping
Shift apex
pneumothorax
What to palpate for
Apex, trachea, chest expansion, tactile vocal fremitus
Percussion
Dull: consolidation or fluid e.g. pleural effusion (empyema)
Auscultation
Air entry, breath sound, added sounds (wheeze, stridor, crep)
Complete examination
- Lymphdeonpathy
- ENT
- Peak flow
Neuro
What to use as tendon hammer
end of stethoscope
Every child with temp should have when
ENT examination
Best position
Hand behind back, hold head, mothers arm across body.
Dul, pale bulging tympanic membrane
glue ear
Tx: grommet
Burst tympanic membrane
otitis Media or externa
Throat
tonsilitis
- (EBV: petechial on palate)
- any exudate? Spots
- lymphadenopathy
- Score?
