export_pediatric thorax and lung exam

Question 1

Chest wall in infants and children

Answer 1

Rib cage is more circular than adult

AP diameter to lateral diameter decreases significantly during the first three years

Question 2

Diaphragm in the infant and child

Answer 2

Horizontal, decreased contraction efficiency

Muscles of inspiration become less fatigued as a child ages

Question 3

Lungs in infants and children

Answer 3

Alveolar multiplication after birth continues up to two years old
Alveolar size continues to increase until thoracic growth is complete

Question 4

Where do you start for a pediatric lung exam?

Answer 4

ABCs
Airway

Breathing

Circulation

Question 5

Respiratory rate for a newborn

Answer 5

40-60 bpm

Question 6

Infant breathing patterns

Answer 6

• Obligate nasal breathers
• Periodic breathing
  When assessing respiratory rate, must take it for one full minute

Question 7

Periodic breathing

Answer 7

Breathing pattern for infants within the first month of life, where they will breathe rapidly for several seconds, then not breath for up to 20 seconds afterwards
Anything longer than 20 seconds is APNEA

Question 8

Things to monitor in lung exam

Answer 8

Respiratory rate and effort

Retractions

Question 9

Types of retractions during respiratory distress

Answer 9

Suprasternal
Subcostal

Intercostal

Question 10

Auscultation of the infant lungs

Answer 10

Differentiated lung sounds from heart sounds can be a challenge
Sounds transmit easier in the infant than they do in an adult

Question 11

How do you get a quiet infant?

Answer 11

Feed them
Pacify them

Have parent hold them

Get them to fall asleep

Question 12

What is included in the cardiac exam?

Answer 12

Heart auscultation
Lung exam

Liver exam

Skin

Pulses

Question 13

Acrocyanosis

Answer 13

Peripheral cyanosis

- Normal finding in a neonate and is not worrisome

Question 14

Central cyanosis

Answer 14

Abnormal at any age

Can be pulmonary or cardiovascular in etiology

Question 15

How can you differentiate between cardiac and pulmonic causes of central cyanosis?

Answer 15

Hyperoxitest:
Check ABG, provide 100% O2 for 10 minutes, recheck ABG

If pO2 rises > 100 mmHg, the cause is likely pulmonary

Question 16

Where is the newborn apical impulse?

Answer 16

In the 4th or 5th intercostal space just medial to the midclavicular line

Question 17

What would cause the apical impulse to shift?

Answer 17

Pneumothorax
Dextrocardia
Diaphragmatic hernia

Question 18

Normal newborn heart rate

Answer 18

120-160 bpm

Question 19

If a baby has a “machinery murmur”, what does this indicate?

Answer 19

Patent ductus arteriosis

Question 20

What blood pressure would indicate a hypertensive infant?

Answer 20

higher than 80/50

Question 21

Innocent murmurs

Answer 21

Common from 3-7 years old
Maximally audible at mid left sternal border

Midsystolic

Heard better when supine and least when standing/holding breath

Question 22

Pathologic murmur

Answer 22

Abnormal cardiac size or ECG
Diastolic murmur

Cyanosis

Abnormally weak or strong pulses

Loud, with thrill, or transmits through thorax

Question 23

Normal capillary refill time

Answer 23

1-2 seconds