exam Flashcards
ASD
- systolic ejection murmur
- heard at LUSB
- right ventricular hypertrophy
- cardiomegaly
VSD
- systolic ejection murmur
- holosytolic thrill may be felt at LLSB
- cardiomegaly
PDA
- heard at LUSB
- holosystolic “machinery” sound
Transposition of Great Arteries
- thrill at LLSB
- x-ray: “egg on a string”
TOF
- loud systolic ejection click at middle and LUSB
- Boot shaped heart
- running and then squat
Aortic Stenosis
- systolic thrill at RUSB
- systolic ejection click that does not vary with respirations
Pulmonic Stenosis
systolic, loudest at LUSB
- ejection click that decreases with inspiration and increases with expiration
- thrill at LUSB radiating to the back and sides
Coarctation of Aorta
- systolic ejection murmur with radiation to the left interscapular area
- BP and pulses in LE is less than UE
Stills Murmur
musical
- Louder when supine
Venous Hum
humming murmur that is best heard in sitting position and disappears when supine
- also disappears when turning head
Rheumatic Fever
- needs 2 major or 1 major and 2 minor to diagnose
Major: carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules
Minor: arthralgia without inflammation, fever >102.2, elevated ESR and CRP, prolonged PR interval on EKG
Kawasaki
- at least 4 criteria
- fever for 5 days
- polymorphous rash
- peeling lips
- changes in extremities (edema, peeling skin)
- cervical lymphadenopathy
- bilateral conjunctival injection without exudate
Pityriasis Rosea
- common to have a recent URI
- herald patch initially then pruritic rash in christmas tree pattern found on trunk within 1-2 weeks
- sunlight will help heal faster
Lyme Dz (diagnostics and management)
- ELISA screening and Western Blot
- under 8yr Amoxicillin or cefuroxime
- over 8 yr Doxycycline
PNA in newborns
GBS, chlamydia, E.coli
PNA in infants and toddlers
RSV, H. influenzae, S. pneumoniae,
PNA in preschool -young adulthood
S. pneumoniae, Mycoplasma, Chlamydia
PNA in immunocompromised
pneumocystitis jirovecii or fungi
Osgood Schlatter
10-14 yo
pain in tibial tuberacle
enlargement of 1 side
self limiting
Toxic Synovitis
3-8 yo
painful limp
unilateral involvement
internal rotation of hip causes spasm
no signs of infection
self limiting
Leg-Calve-Perthes
4-10 yo
limp with knee pain and may migrate to groin/lateral hip
limited passive internal rotation and abduction of hip
Observation: less than 6, involvement of < 1/2 femoral involvement, and FROM preserved
Ortho: > 1/2 involvement or older than 6 yo
Kernig’s SIgn
sign for Meningitis: flexion of the hip at 90 degrees, pain on extension of the leg
Brudzinski’s sign
sign for meningitis: involuntary flexion of the legs with neck is flexed
criteria for neurofibromatosis diagnosis
at least 2 of the following:
- 6 or more CLS >5mm in prepubertal child or >15 mm in postpubertal
- 2 or more cutaneous neurofibromas
- axillary or inguinal freckling
- 2 or more iris Lisch nodules
- distinctive osseous lesions
- optic glioma
- autosomal dominant; present in 1 st degree relative
Lead poisoning
- <3.5 - follow up blood testing
- 3.5-19: ensure iron sufficiency
- 20-44: consider abd xray, full exam and hx to check for signs and symptoms
- > 45 admit to hospital, chelation therapy
Somogyi effect
- hypoglycemic at 3am, then rebounds with hyperglycemia at 7am
- reduce or eliminate bedtime insulin
Dawn Phenomenon
sugar gets progressively higher through the night and is elevated at 7 am
- add or increase dose of bedtime insulin
