exam I Flashcards
ligamentum trite
bleeding above this will be melena, below will be red
visceral pain
aka colic
comes and goes, crescendo/decrecendo
not well localized
parietal pain
steady ache, well localized
kurrs sign
spleen referred pain to left shoulder
pancreas referred pain
right shoulder
expose abdomen
from xiphoid to pubic symphisis
bowel sounds
normal- high pitched ‘tinkle’ about every 3-5 seconds
no sounds for 2 minutes- report as absent
borborygmi
increased hyperactive bowel sounds
low pitched rumbling
hyperperistalisis
percussion of abdomen
tympany over intestines
dull over liver
liver
should be less then 10 cm along MCL
Fluid wave
place patients or assistants hand in midline
tap on one flank and palpate w/the other hand, easily detected impuse indicative of ascites
shifting dullness
percuss the patient on their back and then their side, where the sound changes from tympany to dull and the shift of the sound when patient on their side
shift indicative of ascites
rebound pain
peritoneal tenderness and inflammation
Rovsing sign- referred rebound tenderness test LLQ but get pain in RLQ
palpation of liver
under right 11th and 12th rib
palpation of spleen
under left 11th and 12th ribs
Llyods sign
CVA (costovertebral angle) tenderness during kideny percussion
obturator sign
place right lef in figure 4 press on right knee while holding down left iliac crest- appendicitis
appendicitis
annorexia!! nausea, vomiting pain rovsing sign psoas pain obturator sign
lower abdominal pain
MUST DO RECTAL
PREGNANCY EXAM IN FEMALES
murphys sign
RUQ pain, sudden arrest of inspiration during palpation of liver and gallbladder -> acute cholecytitis
diagnostic tirad
RUQ pain, fever, and leukocytosis ->acute cholecystitis
five ‘f’s
female, fat, fertile, fair, flatulent -> acute cholecytitis
newborn
0-28 days
infancy
0-12
toddler/early childhood
1-4 yrs
school-aged/middle childhood
5-10
adolensence
11-20, subdivided into early, middle, late
APGAR
A- appearance P-pulse G- grimace A- activity R-respiratory effort assesses neuroglogic recovery each rated on a 0-3, 3 the best done at 1 and 5 minutes
shortly after delivery
erythromycin ointment in eyes, prevents infection
vitamin K injection to prevent bleeding
full bath
ballard scoring system
to determine gestational age
nueromuscular -1-5
physical maturity -1-5
add both categories and use scale to get age
this considered more accurate then mom n dads dates
normal birth weight
> 2,500 grams
weight
normal to loose up to 10% in first week
should be gained bak in 10-14 days of life
voiding
3-4 in first 1-2 days by day 5-5 should see 6-8 in 24 hours
stooling
initial stools are meconium, w/in first 24 hours of life, dark black, tarry
by day 4-5 stool changes depending on diet
jaundice
transcutaneous bilimeter or serum w/in 24 hours
elevated levels with in first 24 hours more concerning
photobathing
hospital discharge
vaginal 2-days
c-section 3 days
given hep B, hearing screen, neonate screening blood test, circumcision
follow up
24-48 hours
weight?
bilirubin?
well visits
3-4 days of life 2wks (not in all states) 1mo 2mo 4mo 6mo 9mo (check hemoglobin) 12mo
components used to assess development
physical (gross and fine motor)
language/cognative
personal/social
language
2 months- cooing
6 months- babbling
1yr- 1-3 words
palmar grasp
place finger in hand and press, fingers curl around your finer, disappear by 4 mo
plantar grasp
touch sole at base of toes -> toes curl
gone by 9m
rooting
stroke perioral skin at corner of mouth-> mouth opens and turn head towards stimulation
gone by 3-4 mo
hip exam
use barlow and ortolani maneuvers to test for signs of dislocation
DHD- developmental hip dysplasia, need imaging to diagnose
tests are reliable up to 3mo, but then hip capsule tightens, other signs -> galeazzi
ortolani test
posterior hip dislocation
externally rotate with fingers underacetabulum pushing anterior, will put it back in place
barlow
`tests for ability to sublux intact, but unstable hip
internally rotate pushing acetabulum posterior, will dislocate
stills murmur
grade II, musical, vibratory midsystole, worse when patient supine
venous hum
sof continuous, louder in diastole
carotid bruit
midsystolic, louder on left, eliminated by carotid compression
tanner breast
1- preadolescent, elevation of nipple only
2-elevation breast, nipple small mound
3- further enlargement of breast/areola, no separation of contour
4- projection of areola/nipple to form secondary mound
5- mature, projection of nipple only
tanner female pubic hair
1- preadolescent, no hair except for fine body hair
2- sparse growth of long slightly pigmented downy hair, straight or slightly curly, along labia
3-darker, curlier, spreading to pubic sympthysis
4- course and curly hair, not yet on thigh
5- spread out onto inner thigh
tanner-male 1
1- preadolescent, no hair, penis/testes same size as childhood
tanner- male 2
2-pubic hair sparse slightly pigmented, penis slight to no enlargement, testes/scrotum larger, slightly reddened
tanner male 3
3- pubic hair darker, coarser, curlier, localized, penis larger in length, testes further enlargement
tanner male 4
4-pubic hair coarser, curlier, not yet on thighs
further enlargement length, breadth w/developement of glands
tanner male 5
5- pubic hair spread to thigh, penis/scrotum adult size and shape
when do you start doing exam on parents lap
9 months, this is when they develop a sense of strangers
head circumfrence
measured until 36 months
vaccines by 6 months
- Hepatitis B (Hep B)
- Rotavirus (RV)
- Diphtheria, tetanus, acellular pertussis (DTaP)
- Haemophilus influenza type B (HIB)
- Pneumococcal (PCV)
- Inactivated poliovirus (IPV)
- Influenza
vaccines by 12 months
- Measles, mumps, rubella (MMR)
- Varicella
- Hepatitis A (Hep A)
puberty begins
8-13 females
9-13.5 males
early adolescences
10-14 puberty begins concrete operational focus on present 'am I normal' independence/ambivalence
middle adolescence
15-16
physical- females more comfortable, males more awkward
transitional- many ideas
begin to develop insight, reflect on thoughts/feelings of others
‘who am i’ introspective
independence, rebellious, push boundaries
late adolescence
17-20 adult appearance formal operative identify self w/respect to others independence from family
adrenarche
Activation of adrenal medulla for production of adrenal androgens
Occurs before the onset of puberty
Gonadarche
Earliest gonadal changes of puberty-GnRH released
Boys-LH stimulates testosterone production and FSH stimulates sperm maturation
Girls-FSH stimulates estrogen & follicle formation and LH stimulates corpus luteum after ovulation
Thelarche
Beginning of breast development at puberty
Pubarche
Beginning of pubic hair
Ab pain thru 1yr
- Colic
- Gastroenteritis
- Constipation
- Urinary tract infection
- Intussusception
- Volvulus
- Incarcerated hernia
- Hirshsprung’s Disease
Ab pain 2-5 yrs
- Gastroenteritis
- Trauma
- Appendicitis
- Pharyngitis
- Constipation
- Urinary tract infection
- Intussusception
- Sickle cell syndrome
- Henoch-Schonlein purpura
- Volvulus
- Mesenteric lymphadenitis
ab pain 6-11 yrs
- Gastroenteritis
- Trauma
- Appendicitis
- Pharyngitis
- Constipation
- Urinary tract infection
- Pneumonia
- Sickle cell syndrome
- Henoch Schonlein purpura
- Functional pain
- Mesenteric lymphadenitis
ab pain 12-18 yrs
- Appendicitis
- Gastroenteritis
- Constipation
- Dysmenorrhea
- Mittelschmerz
- Pelvic inflammatory disease
- Threatened abortion
- Ectopic pregnancy
- Ovarian/testicular torsion
things that cause mesenteric lymphadenitis
Beta hemolytic streptococcus Staphlococcus species E. coli Streptococcal viridans Yersinia species (most cases currently) Mycobacterium tuberculosis Viruses Coxsackievirus A & B Rubeola virus EBV Adenovirus serotypes 1,2,3,5 & 7
labs to run if jaudice w/in 24 hours
Sepsis panel CBC, CMP, DIC panel Rubella abs Toxo abs Coombs test ABO/Rh typing CBC/Retic count Periph smear Fractionated bilirubin level
labs to run if jaundice in a 24hours-2wks
Fractionated bilirubin level Includes direct and indirect (conjugated &unconjugated) CBC Retic count Peripheral smear
labs to run if jaundice after 2 wks
CBC/retic Fractionated bilirubin level Urine bili levels Thyroid studies Sepsis eval Genetics for metabolic disorders
phimosis
cannot retract foreskin back over penis
hygiene issues root cause
Paraphimosis
cannot pull foreskin back around glans
Cryptorchidism
undescended testicles
syphillis
causative organism Treponema pallidum
Syphilitic Chancre – painless round or oval erosion or ulcer. Non-tender enlarged inguinal lymph nodes are common.
RPR and VDRL are positive, screening test, many false positives.
FTA- ABS is positive or Dark Field Microscopy, confirmatory test.
Genital Herpes
cluster of small vesicles. Burning and painful. Progress to ulcers on a erthymic base.
Dx – viral culture of the fluid in the vesicle.
Herpes simplex virus 1 and 2 need serological testing to determine which one
Venereal warts
(Condyloma acuminatum) - caused by HPV (human papillomavirus. Grow in clusters.
Difficult to treat – cryosurgery, laser surgery, electrosurgery, podophyllin, Aldara(imiquimod), surgery.
Genital Scabies
Genital Scabies:
- Contagious disease caused by a mite (Sarcoptes scabiei)
- Direct skin contact.
- Nocturnal pruritus is very characteristic progressing to intense pruritus.
- Linear, curved or s-shaped burrows.
- Diagnosis: clinical suspicion, slide mount preparation.
- Treatment: Permethrin cream (Elimite), Lindane; oral steroids or antihistamines for pruritus.
Gonococcal Urethritis
purulent discharge
Gram-negative intracellular diplococci of GC
WBC = neutrophils
axillary tail drains to
subscapular grp of axillary nodes
upper breast drains to
subclavicular nodes
medial beast drains to
submammary plexus of the opposite
breast
lymph glands along the internal thoracic artery -> mediastinal nodes
inferior breast drains to
lymp of ab wall and to extraperitoneal lymph
