Pedia 3B - Applied Pediatric Ward Flashcards
Heterophoria
Latent tendency for the eyes to deviate
Amaurosis
Partial or complete blindness
Orthophoria
Ideal condition of exact ocular balance
Heterotropia
Constant misalignment of the eyes
Dyscoria
Abnormal shape of the pupil
Scaphocephaly
Head is elongated in the AP diameter
Turricephaly
Top of the head is pointed
Plagiocephaly
One side of the head is more rounded
Oxicephaly
Tower head
Absence of clavicle
Cleidocranial dyostosis
Presternal edema
Mumps
Supernumerary nipples
Renal anomaly
Pigeon breast
Rickets
Shield chest
Turner’s Syndrome
Hyper-resonant on percussion
Emphysema
Dullness on percussion
Consolidation
Increase vocal resonance
Consolidation
Age Related: Infancy
Behavioral problem:
Child neglect
Age Related: Pre-school
Behavioral problem:
Breath holding
Age Related: School age
Behavioral problem:
Bed wetting
Age Related: Adolescence
Behavioral problem:
Acting out behavior
Lesions - 1’ or 2’
Macule
Primary
Lesions - 1’ or 2’
Papule
Primary
Lesions - 1’ or 2’Excoriation
Secondary
Lesions - 1’ or 2’
Crust
Secondary
Lesions - 1’ or 2’
Wheal
Primary
Lesions - 1’ or 2’
Ulceration
Secondary
Lesions - 1’ or 2’
Scar
Secondary
Finding: Exaggerated reflexes
Disease Associated:
Dse of CNS
Finding: Dark Urine
Disease Associated:
Myoglobiuria
Finding: Sensory changes
Disease Associated:
Peripheral Nerve Dse
Finding: ??
Disease Associated:
Anterior Horn Disease
Type of Rash: Malar Rash
Disease Associated:
SLE
Type of Rash: Erythema marginatum
Disease Associated:
ARD Acute rheumatic disease
Type of Rash: Purpuric Spots over distal portion of extremities
Disease Associated:
HSP Henoch Schonlein Purpura
Type of Rash: Evanescent macular rash
Disease Associated:
JRA Juvenile rheumatoid arthritis
Sexual Maturity Rating:
Nipple and areola form a secondary mound
IV
Sexual Maturity Rating:
Scrotal skin is pink/reddened
II
Sexual Maturity Rating:
Lanugo-like straight lightly pigmented pubic hair
II
Sexual Maturity Rating:
Larger penis with glans and penile breath increased in size
III
Sexual Maturity Rating:
Abundant dark and curly pubic hair spreading to the medial thighs
V
Sexual Maturity Rating:
Breast bud stage
II
Sexual Maturity Rating:
Elevation of papillae only
I??
Lesion: Strawberry nevi
Diagnosis:
Capillary hemagiomata
Lesion: Light or dark brown lesion usually seen in sun-exposed parts of the body
Diagnosis:
Hyper-pigmentation lesions (FRECKLES)
Finding: Single umbilical cord + Imperforate anus
Diagnosis:
Muscle
Renal - Ans?
Cardio
Finding: Large tongue + umbilical hernia
Diagnosis:
Hypothyroidism - Ans ?
Down syndrome
Hernia
Finding: Incessant crying
Diagnosis:
Temp
Feeding
Bowel movement
AOTA??
Finding: Myoclonus knee jerk in 2 week neonate
Diagnosis:
Physiologic
Finding: Concave nails (koilonychia)
Diagnosis:
IDA
Plummer Vinson Syndrome
Finding: Generalized hypotrichosis
Diagnosis:
hypothyroidism??
Finding: Harrison’s groove
Diagnosis:
Rickets or COPD
Finding: Abdominal pain made WORSE by squeezing is likely due to some ________ condition
Diagnosis:
Inflammatory
Information: Parity + Gravidity of the Mother Parts of the History: - Prenatal - Natal - Neonatal
Prenatal
Information: Severity of Jaundice Parts of the History: - Prenatal - Natal - Neonatal
Neonatal
Information: Spontaneous breathing at birth Parts of the History: - Prenatal - Natal - Neonatal
Natal
Information: History of Phototherapy Parts of the History: - Prenatal - Natal - Neonatal
Neonatal
Information: APGAR score of 8 Parts of the History: - Prenatal - Natal - Neonatal
Natal
History and PE Finding: Child swallows dirt, crayon, chalk etc
Condition:
PICA
History and PE Finding: Generalized jaundice except the sclera
Condition:
Lycopenia
History and PE Finding: Excessive thirst and water intake
Condition:
Polydipsia
History and PE Finding: Child regurgitates food into the mouth and chews on it
Condition:
Rumination
History and PE Finding: Patient is blue w/o dyspnea
Condition:
Met-hemoglobinemia
Description: Unsteady gait
PE Findings:
Ataxia
Description: Pulse rate INC w/INSP and DEC w/EXP
PE Findings:
Sinus Arrhythmia
Description: Pulse Volume DEC (or disappears) at end of INSP
PE Findings:
Pulsus paradoxus
Description: Rapid, deep respiration in metabolic acidosis
PE Findings:
Kussmaul’s breathing
Description: ALT periods of deep and shallow respiration w/recurring periods of apnea
PE Findings:
Cheyne stokes?
Compare w/Biot’s
To visualize tympanic membrane of older child, the pinna of the ear is held by fingers of one hand and gently pulled:
Up and back
Younger - DOWN
Major Salivary gland(s) located below and in front of the external auditory meatus is/are the:
DON’T KNOW
Submaxillary
Sublingual
Parotid
Complete set of milk (primary) teeth at 24 months:
20
Accessory muscle of expiration
Abdominal INSP - SCM - Scalenii - Trapezii
DEC vocal fremitus over A Collapsed lung B Pleural Effusion C Lung consolidation D A&B
?? I think D
Primary lesion is flat and flushed w/surface of skin blanching w/pressure
Macule
Bronchial breathing is considered abnormal if heard over the
Lower aspect of the anterior chest NORMAL - Trachea - Midline of upper anterior chest - Either side of the 2nd thoracic spine, over the posterior chest in small infants
Last part of PE (esp in young children)
EARS
The ff information is included in the hx of the PERSONAL habits of the patient EXCEPT
- School performance
- Sleeping
- Toileting
- Games and play
Personal habits
- Feeding
- Sleeping
- Toilet
- Games/Play
- Living condition
The ff are immediate reflection of adequate nutrition of an infant EXCEPT:
- sleeps after feeding
- Plays
- quiet after feeding
- Gaines weight
Sleeps after feeding?
Description: Shrieking cry
Diagnosis:
CNS disease
Description: Peripheral cyanosis, compared to central,
Diagnosis:
Tongue is not blue
Cold extremities
Description: Green colored watery stools
Diagnosis:
Rapid intestinal peristalsis
Difference between diastolic pressure of upper and lower limbs
NONE
Systolic difference = 5-10 mmHg higher in lower limbs
Normal resp rate of a NB
?? 30-50 ??
Normal Tachypnea
0-2m 30-50 >60
2-12m 20-30 >50
1-5y 20-30 >40
6-12y 15-20 >30
12-18y 12-18 >24
Palpable or not, NB has __ fontanels
SIX
Clinical History: G2P3 Type of History: - Prenatal - Natal - Neonatal
Prenatal
Clinical History: Mother's age Type of History: - Prenatal - Natal - Neonatal
Prenatal
Clinical History: Polyhydramnios Type of History: - Prenatal - Natal - Neonatal
Natal
Clinical History: Phototherapy Type of History: - Prenatal - Natal - Neonatal
Neonatal
Clinical History: APGAR Type of History: - Prenatal - Natal - Neonatal
Natal
Finding: Muscle weakness w/rashes
Diagnosis:
Collagen vascular disorders
Finding: Joint tenderness, as a sign of arthritis should be differentiated from
Diagnosis:
Proximal bone tenderness
Tenderness along tendon attachments
Bone pain of leukemia
Finding: Erythema marginatum
Diagnosis:
ARF Acute rheumatic fever
Finding: Tenderness of sacro-iliac joint elicited by
Diagnosis:
Pretzel test
Finding: Ortolani’s maneuver
Tests for:
Hip displacement
Finding: Grower’s test
Diagnosis: ?
DMD
Finding: Tenderness over tibial tubercle suggests
Diagnosis:
Sarcoma
Finding: TRUE migrating pain can be seen in
Diagnosis:
Rheumatic fever
Finding: Excessive tearing may be d/t
Diagnosis:
Allergy
Local irritation of eyes
Crying
Finding: Failure of the fontanels to close by 18 months
Diagnosis:
Hydrocephalus
Ricketts
Hypothyroidism
Finding: Unusually long eyelashes
Diagnosis:
Malnutrition
Some normal
Finding: Hx of Doctor-shopping
Diagnosis:
Possibility of pediatric Munchhausen
What is Sandifier Syndrome
Number of pregnancies reaching the age of viability =
Parity
Number of pregnancies, regardless of viability
Gravida
Snoring is a form of ______ observed during sleep
STRIDOR
Generalized Cyanosis (inc tongue) + warm extremities
CENTRAL
Height should be measured in the ______ position in infants and children less than ___ years old
Supine
<3 years old
Head circumference is measured
1” above the Glabella
Max point of the Occipital protuberance
Axillary temp is usually _____ lower/higher than oral
0.5’ lower
Head Circumference > Chest Circumference until ____
6 months of age
Sinus arrhythmia is characterized by RAPID pulse during ______ and SLOWER during
RAPID - INSP
SLOWER - EXP
Narrow cuff gives a ____ reading
Wide cuff gives a ____ reading
Narrow - HIGHER
WIDE - LOWER
Lesions: Crust
Type: 1’ or 2’
2’
Lesions: Petechiae
Type: 1’ or 2’
1’
Lesions: Excoriation
Type: 1’ or 2’
Secondary
Lesions: Atrophy
Type: 1’ or 2’
Secondary
Lesions: Pustule
Type: 1’ or 2’
Primary
Prenatal
Natal
Neonatal
Gravity & Parity
Prenatal
Prenatal
Natal
Neonatal
Severity of Jaundice
Neonatal
Prenatal
Natal
Neonatal
Spontaneous breathing at birth
Natal
Prenatal
Natal
Neonatal
History of phototherapy
Neonatl
Prenatal
Natal
Neonatal
APGAR
Neonatal
History and PE
Child swallows dirt, crayon, chalk
PICA
History and PE
Generalized jaundice except the sclera
Lycopenia
History and PE
Excessive thirst and water intake
Polydipsia
History and PE
Child regurgitates food into mouth and chews on it
Rumination
History and PE
Patient is blue w/o dyspnea
Met-hemoglobinemia
History and PE
Generalized cyanosis and warm extremities
Central cyanosis
History and PE
Cyanosis
(Excluding tongue and w/cold extremities)
Peripheral cyanosis
History and PE
Pacified swallowing
Dysphagia
History and PE
Failure of muscle coordination
Ataxia
History and PE
Unsteady gait
Ataxia
History and PE
Pulse rate INC w/INSP and DEC w/EXP
Sinus arrhythmia
History and PE
Pulse volume DEC (or disappears) at end of INSP
Pulsus paradoxus
History and PE
Rapid, deep respiration in metabolic ACIDOSIS
Kussmaul’s breathing
History and PE
Alt period of deep and shallow respiration w/recurring periods of apnea
Biot’s breathing
History and PE
Lying still in bed and don’t want their abdomen touched
Peritoneal irritation
History and PE
Irritability and dyspnea worsening on lying flat
Congestive heart failure
History and PE
Shrill shrieking and high pitched cry
CNS disease
History and PE
Abdominal pain AGGRAVATED by palpation
Abdominal pain secondary to inflammation
History and PE
Abdominal pain relieved by palpation
Abdominal pain secondary to SPASM
4m w/head circumference larger than chest circumference
NORMAL
H > C 4-6m
History and PE
12m old w/head circumference larger than chest
Marasmus
Hydrocephalus
EV Syndrome (small thorax)
History and PE
Noisy musical sound on respiration heard even w/o stethoscope
Wheeze
Prenatal
Natal
Neonatal
Mother’s age
Prenatal
Prenatal
Natal
Neonatal
Polyhydromnios
Prenatal
Prenatal
Natal
Neonatal
Meconium staining
Natal
Prenatal
Natal
Neonatal
Duration of nursery stay
Neonatal
Prenatal
Natal
Neonatal
Severity of Jaundice
Neonatal
Prenatal
Natal
Neonatal
Maternal intake of metformin
Prenatal
Prenatal
Natal
Neonatal
NSD
Natal
Neonatal Nutritional Natal Past Medical Social and Personal Family Health history of the yaya
Family
Neonatal Nutritional Natal Past Medical Social and Personal Family Are these the Natural parents?
Family
Neonatal Nutritional Natal Past Medical Social and Personal Family Usual eating pattern
Social and personal
Neonatal Nutritional Natal Past Medical Social and Personal Family Is there bed wetting
Social and personal
Neonatal Nutritional Natal Past Medical Social and Personal Family Was phototherapy done?
Neonatal
Neonatal Nutritional Natal Past Medical Social and Personal Family 40th week of gestation
Neonatal
Neonatal Nutritional Natal Past Medical Social and Personal Family Exchange transfusion was done
Past medical
Neonatal Nutritional Natal Past Medical Social and Personal Family APGAR score
Natal
Neonatal Nutritional Natal Past Medical Social and Personal Family Two cord coils
Natal
Neonatal Nutritional Natal Past Medical Social and Personal Family Presence of cataract
Neonatal
History and PE
Blood in the sputum
Hemoptysis
History and PE
History of repeated accidents
Past medical
History and PE
Pattern of weight gain
Nutrition
History and PE
Age of weaning
Nutritional
History and PE
Purposeless, repetitive movement
Tics
History and PE
Double vision
Diplopia
History and PE
Involuntary discharge of urine occuring during sleep at night
Enuresis
History and PE
Sensation as if surrounding objects are going round and round
Vertigo
History and PE
Purposeless, non-repetitive involuntary movement
Chorea
History and PE
Slow writhing movements of the distal portion of the extremities
Athetosis
History and PE
Purposeless, non-repetitive movement
Chorea
History and PE
Rapid, oscillatory movements present AT REST
Tremor
History and PE
Slow, rhythmic movements of the extremities and the face
Athetosis
History and PE
Intermittent contractions of a single muscle (or group) resulting in quick, jerky motion of a limb
Myoclonus
Decerebrate or Decorticate
Ext of the neck
Decerebrate
Decerebrate or Decorticate
Flexion of the elbows and wrists
Decorticate
Decerebrate or Decorticate
Extension of the LOWER limbs
Decerebrate and Decorticate
Decerebrate or Decorticate
Pronation of the forearm
Decorticate
Decerebrate or Decorticate
Ext at the elbows
Decorticate
Skin lesions
Blanch w pressure
Macule
Skin lesions
Do NOT blanch w/pressure
Petichiae
Skin lesions
Confluent papules
Plaques
Skin lesions
Larger lesions are called bullae
Vesicles
Skin lesions
Central portion of the lesion paler than periphery
Wheals
Normal or Abnormal
Hydrocele at 3 months
Normal (up to 3 months)
Normal or Abnormal
L scrotum is at a lower level than the right
Norma
Normal or Abnormal
Active bowel sounds in late intestinal obstruction
ABnormal
Normal or Abnormal
Kidney best felt in deep INSP
Normal
Normal or Abnormal
Milky white breasts secretions in a 5d neonate
Normal
Normal or Abnormal
Systolic blood pressure in the lower limbs is higher than upper
NORMAL
Normal or Abnormal
Pulse is rapid during INSP and slower during EXP
Normal
Normal or Abnormal
Head circumference remains larger than chest until 1 year old
Abnormal
Normal or Abnormal
APGAR score of 6
Abnormal What's normal? 7 or greater = Good 4-6 - Asphyxiated --> Observe 3 or less --> Resuscitation
Normal or Abnormal
Newborn infant w/ weight loss of 20% after birth
ABnormal
10% is normal
Social/Personal Natal Neonatal Nutritional Family Yaya diagnosed with milk PTB
Family
Social/Personal Natal Neonatal Nutritional Family Sources of support
Social/personal
Social/Personal Natal Neonatal Nutritional Family Baby sleeps after feeding
Nutritional
Social/Personal Natal Neonatal Nutritional Family Exchange transfusion
Neonatal
Social/Personal Natal Neonatal Nutritional Family Oliohydromnios
Natal
Prenatal Natal Neonatal None Term of pregnancy
Prenatal
Prenatal Natal Neonatal None Phototherapy?
Neonatal
Prenatal Natal Neonatal None Polyhydramnios
Natal
Prenatal Natal Neonatal None Meconium staining
Natal
Prenatal Natal Neonatal None Adequacy of milk intake
None
Nutritional?
Prenatal Natal Neonatal None Teenage pregnancy
Prenatal
Prenatal Natal Neonatal None G1P1
Prenatal
Prenatal Natal Neonatal None Birth weight
Natal
Prenatal Natal Neonatal None Forceps delivery
Natal
Prenatal Natal Neonatal None Induced labor
Natal
Physiologic or Pathologic
Cephal-hematoma
Physiologic
Physiologic or Pathologic
Ebstein pearls
Physiologic
Physiologic or Pathologic
Erythema toxicum
Physiologic
Def: common rash in neonates. Appears in up to half of newborns carried to term usually 2-5 days after birth; it does not occur outside neonatal period.
Blotchy red spots on skin w/overlying white or yellow papules or pustules.
Physiologic or Pathologic
Positive ankle clonus at 1 week
Physiologic
Physiologic or Pathologic
Unequal Moro reflex
Pathologic
Physiologic or Pathologic
Caput succedanum
Abnormal
Def: Neonatal condition involving sero-sanguinous, subcutaneous and extra-periosteal fluid collection w poorly defined margins cause by pressure of the presenting part of the scalp against the dilating cervix during delivery
Physiologic or Pathologic
Scaphoid abdomen at birth
Physiologic
Physiologic or Pathologic
Bounding dorsalis pedis pulses
Physiologic
Physiologic or Pathologic
Millia over the tip of the nose at 3 days of life
Pathologic
Milia are small raised pearly white or yellowish bumps on the skin usually around cheeks nose eyes, forehead and chest
Common in newborns
Tiny skin cyst filled w/keratin
Physiologic or Pathologic
Peripheral cyanosis at 4 hours of life
Pathologic
Physiologic or Pathologic
36.7’ C at 24h of life
Abnormal
Physiologic or Pathologic
Head circumference of 34cm
Abnormal
Physiologic or Pathologic
Globular abdomen at 48h of life
Abnormal
Physiologic or Pathologic
RR of 60/min at 1h of life
Abnormal
Physiologic or Pathologic
(-) Fencing reflex at 1w
Normal
Physiologic or Pathologic
Consumes 15cc of breastmilk at 12h of life
Abnormal
Physiologic or Pathologic
(+) GRasp reflex at 24h of life
ABnormal
Physiologic or Pathologic
Passage of urine at 30h of life in 34 week neonate
Abnormal
Physiologic or Pathologic
(+) Crepitations over the clavicular area
Normal
Physiologic or Pathologic
(+) Head lag at 2w of life
Abnormal
Physiologic or Pathologic
Hydrocoele at 3m
Normal
Physiologic or Pathologic
Umbilical cord stump falls off at 21 days
Abnormal?
Falls off 6-18d
Heals 12-21d
Physiologic or Pathologic
Urethral discharge in a 3d male
Normal
Physiologic or Pathologic
Highly pigmented genitalia in a female newborn
Normal
True/False
In taking the hx, remember to have a period of communication with the child even though the parents are speaking
True
True/False
Important to use both open-ended and leading question
True
True/False
During the process of questioning, if a parent does not look in your eyes directly it always means evasion
False
True/False
Following history of doctor-shopping by the family, one must be aware of the possibility of pediatric version of “Sandifier Syndrome”
False
Munchausen
Sandifer syndrome
- spasmodic torsional dystonia
+ arching of the back
+ rigid opisthotonic posturing, mainly involving the neck, back, and upper extremities,
- associated with symptomatic gastroesophageal reflux, esophagitis, or the presence of hiatal hernia
True/False
Gravida is defined as the unmber of pregnancies reaching the age of viability
False
Parity
True/False
Snoring is a form of grunt which occurs during sleep
False
Stridor
True/False
Height should be measured in the supire position in infants and children below 2yo
False
3yo
True/False
Head circumference is measured at the maximum point of the glabella and a point 1 inch above the occipital protuberance
False
1” above the glabella and the most prominent aspect of the occipital protuberance
True/False
Normally at birth, HC > CC ad remains so until 6m
True
True/False
Axillary temperature is lower than oral
True
Axillary temp is at least 0.5’C lower than oral
True/False
Sinus arrhythmia is characterized by rapid pulse during expiration and slower during inspiration
False
Rapid - INSP
Slower - EXP
True/False
A narrow blood pressure cuff will give spuriously high blood pressure reading and broader cuff will give a lower reading
True
True/False
Movement is lost in both pyramidal and and extra-pyramidal dse
True
True/False
Presence of Moro is normal up to 6m
False
True/False
Absence of balancing reflex for sitting after 8months is abnormal
True
True/False
Knee jerk is an example of a deep reflex
True
True/False
Social smile is observed at 3 months
False
True/False
Bloody vaginal discharge among newborns is pathologic
False
Males should NOT have any discharge Meningeal signs:
True/False
Pleural pain gets worse on coughing. Also true for INC ICP
True
True/False
In carotenemia and lycopenemia, the sclera is not icteric
True
True/False
In PICA, aside from mental retardation, there is a history of swallowing anything inedible
False
Mental retardation must be ruled out to consider PICA
