Examination of children

Question 1

What does pectus carinatum suggest?

Answer 1

This is when the sternum is displaced forward, in front of the ribs. (pigeon chested). This is increased AP diameter with prominent sternum.

Question 2

What does hyperinflation suggest?

Answer 2

Chronic obstructive airway disease such as asthma or can be seen acutely in bronchiolitis etc.

Question 3

What is pectus excavatum?

Answer 3

This is a depression in the chest wall above the epigastrium due to a short central tendon of the diaphragm which tethers the lower end of the sternum

Question 4

What is Harrison’s sulcus?

Answer 4

(looks like comas below the ribs, sucking in). There is an indentation/ guttering of the lower ribcage which is either due to an increased diaphragmatic pull (due to chronic respiratory conditions or poorly managed asthma) or can be due to a bone disease such as rickets, where the bones are more easily deformed by normal diaphragmatic action.

Question 5

What is deep sighing breathing seen in?

Answer 5

Acidotic breathing, seen in DKA.

Question 6

When is a stridor heard?

Answer 6

Upper airway obstruction, croup or laryngeal oedema.

Question 7

What condition does a barking cough occur in?

Answer 7

Croup

Question 8

What condition does paroxysms of coughing occur?

Answer 8

Whooping cough

Question 9

What is poor feeding a cardinal sign of??

Answer 9

Heart failure

Question 10

What is precordial bulge and what does it indicate?

Answer 10

The right ventricle pushes the sternum forward. Causes are cardiomegaly, pericardial effusion, retrocardiac tumour/mediastinal tumours, skeletal dysplasia, scoliosis, rickets, lipoma

Question 11

When would the character of a pulse be small in volume?

Answer 11

In shock

Question 12

What would a bounding pulse be present in a child?

Answer 12

In a patent ductus arteriosis

Question 13

What is a thrill?

Answer 13

It is a vibration of a loud murmur

Question 14

What is the mean systolic blood pressure in the neonatal age?

Answer 14

70mmHg

Question 15

What is the mean systolic blood pressure from 6 weeks to 10 years?

Answer 15

95mmHg

Question 16

What is the mean systolic blood pressure by 16 years of age?

Answer 16

125mmHg

Question 17

Where is the liver normally palpable in children?

Answer 17

1-2cm below the costal margin.

Question 18

What is epsteins anomaly?

Answer 18

This is caused by lithium use in pregnancy and It occurs when the posterior leaflets of the tricuspid valve are displaced anteriorly towards the apex of the right ventricle. The creates tricuspid regurgitation (pan-systolic murmur) and tricuspid stenosis (mid-diastolic murmur). There is also enlargement of the right atrium.

Question 19

When does tetralogy of fallout tend to present?

Answer 19

1-2 months of life