Examination Flashcards
If a child is acutely ill then you should perform the ‘60 second rapid assesment’ what does this involv3?
Airway and breathing- do RESP rate and effort, listen for the presence of stridor or wheeze, look for cyanosis
Circulation- HR, pulse volume, peripheral temperature, capillary refill time
Disability- the level of consciousness
What measurements should be taken on examination of child?
Weight (noting previous measurements) Length Head circumference in infants and older children with neurological problems Temperature Blood pressure
What causes clubbing?
Usually associated with chronic suppurative lung disease- cystic fibrosis or cyanotic congenital heart disease
Can be seen in IBD or cirrhosis occasionally
What are signs of laboured/increased work of breathing?
Nasal flaring Expiratory grunting Use of accessory muscles Difficulty speaking or feeding Retraction of the chest wall
When you are looking at the chest in a child, what are you looking for?
Hyperinflation of lungs
Pectus excavatum
Pectus carinatum
Harrison’s sulcus (indrawing of the chest wall from a long term diaphragmatic tug)
What is the normal respiratory rate in children and what is classed as tachypnoea?
Neonates= 30-50 (tachy>60)
Infants= 25-40 (tachy>40)
Older children= 20-25 (tachy>30)
In terms of chest movement, percussion and auscultation of a child with bronchiolitis, what would be the findings on examinations?
Chest movement= laboured breathing Hyperinflated chest Chest recession (most specific)
Percussion
Hyper resonant
Auscultation
Fine crackles heard in all zones
In terms of chest movement, percussion and auscultation of a child with pneumonia, what would be the findings on examinations?
Chest movements would be Reduced in affected side and they would have rapid shallow breaths
Percussion would be dull
On auscultation you would hear crackles and bronchial breathing
In terms of chest movement, percussion and auscultation, what would you find on examination of a child with asthma?
Chest movement- reduced chest movement with hyperinflation
Auscultation- wheeze
Percussion- hyper resonant
In terms of croup, what would you find on examination- chest movement, percussion, auscultation.
Chest movement- stridor
Chest wall retraction
Percussion would be normal
On Auscultation you would hear stridor from the upper away
What are the features of heart failure in children?
Poor feeding/faltering growth Sweating Tachyapnoea Tachycardia Gallop rythm Cardiomegaly Hepatomegaly
What are the features which suggest that a murmur is significant in children?
Any diastolic Thrill Accompanied by other abnormal cardiac signs Conducted all over the precordium Loud
Why should you always feel for the femoral puLse in children?
In coarctation of the aorta, the femoral pulses are difficult to palpate whilst upper limb pulses are easy to feel. In older children there is a brachiofemoral delay.
