Pediatric Exam Flashcards
When is the neonatal period?
1st day to 28th day
What age is an infant?
< 1 year old
What is the name for the blue cast to hands and feet when exposed to cold in an infant?
Acrocyanosis
With acrocyanosis, if blue coloration persists >8hrs or doesn’t disappear with warming or central cyanosis (tongue oral mucosa are blue) what should you suspect?
congenital heart disease
When should jaundice resolve by in newborn infants?
about 1 week
Which common skin finding has red macules with central pinpoint vesicles scattered over body and disappears in about a week?
Erythema toxicum
Pustular melanosis
small vesiculopustules over brown base
*more common in black infants
Milia
common skin finding with pinhead-sized smooth white raised area without erythema on nose, chin, forehead: due to retention of sebum in openings of sebaceous glands
Fontanelle
Area where major sutures intersect
What will a suture feel like on palpation?
ridge
When does the anterior fontanelle (4-6 cm at birth) close?
4-26 months
When doees the posterior fontanelle close (1-2cm at birth)?
2 months
What suggests possibility of neglect between child and caregiver?
lack of eye contact
What is defined as tachypnea in a child older than 1?
> 40 breaths per min
How is a pulse obtained from a child?
- Direct auscultation
- Palpation of heart
- Brachial/radial pulse (peripheral arteries)
In a child, for every 1 degree of fever what happens to HR?
HR is 10-20 beats faster with every degree warmer
Is sinus arrhythmia common in children?
Yes, rate is faster with inspiration and slower with expiration
In children how do you count respirations?
rise and fall of abdomen
How long do you observe respirations in children?
2, 30 sec intervals
or
1 full minute
What are some signs of increased respiratory effort in children?
- Retraction (ribs, supraclavicular notch)
- Use of sternocleidomastoid
- Flaring nostrils
- Paradoxical breathing
When does routine measurement of blood pressure begin?
3 years old
If blood pressure is consistently above the 95th percentile what should be on the differential?
- Kidney disease
- Coarctation of the aorta
Where will blood pressure be higher and lower if there is coarctation of the aorta?
High: above point of coarctation
Low: Beyond point of coarctation
What is the temperature of the TM in relation to oral temperature?
TM is ~1 degree higher than oral temp
What is the technical definition for fever in rectal/ear vs. oral vs. armpit?
rectal, ear (TM) or temporal artery: 100.4 or higher
oral: 100 degrees or higher
armpit: 99 degrees or higher
When measuring height how do you tell that the patient is oriented correctly and looking forward?
outer canthus of eye aligned with external auditory canal
When should BMI start to be recorded?
age 2
Describe growth pattern for infants
- Growth of trunk predominates
- Fat increases until 9 months
Describe childhood growth pattern
- Legs grow fastest
- Prepubertal growth spurt around age 7
Describe adolescence growth pattern
- Trunk and legs elongate
- organs and skeletal mass double in size
Simian crease, single line across palm of hand is associated which what?
- Down syndrome
2. Fetal alcohol syndrome
Where will eczema (atopic dermatitis) be on young children versus older children?
young children: -face -elbow -knees EXTENSOR SURFACES
older children/adults:
-hands, neck, elbows, knees
FLEXOR SURFACES
Impetigo
- highly contagious staph or strep infection of skin
- itching, burning
“honey colored crusts”
Ring worm is a yeast infection of the skin caused by what?
- Tinea capitis (on head)
- Tinea corporis (on body)
What are some of the facial characteristics of fetal alcohol syndrome?
- Smooth philtrum
- wideset eyes
- mild ptosis (lid drooping)
- hirsute forehead
- short nose
- thin upper lip
Which lymph node region enlargement is always considered abnormal
supraclavicular
When are visual acuity tests with the snellen E chart started?
age 3
Which chart is used to assess distance vision?
Snellen
What is the name for reduced vision in an eye that appears structurally normal?
ambyopia “lazy eye”
By what age would you anticipate a child have 20/20 vision?
6 years old
If you elict a white reflex instead of a red eye reflex what should you be concerned for?
retinoblastoma
What is the name for a convergent eye pointing inward?
esotropic
What is the name for a divergent eye pointing outward?
exotropic
What could low or poorly shaped auricles suggest?
- renal disorder
- congenital abnormalities
What is the treatment for mastoiditis?
This usually results from untreated otitis media -should treat with IV antibiotics
What does a red and inmobile tympanic membrane suggest?
infection in the middle ear
Saddle -shaped nose with collapse of the bony portion may be associated with what?
congenital syphilis
Strawberry tongue is a feature of what illness?
Scarlet fever (group A strep)
What does an adherent white patch in the mouth suggest?
Candidiasis (thrush)
Which virus causes Mononucleosis?
Epstein-Barr virus
most common in teens
What symptoms are associated with epiglottitis?
- Sudden high fever
- Drooling ***
- croupy cough
- Respiratory distress. Tripod position 2 neck extended
NO TONGUE BLADE!!!!
Auscultation of lungs: children
- breath sounds louder, harsher and more bronchial
- Hyperresonance is common
Where is the apical impulse observed in a child?
4th and 5th left intercostal space
-heart lays more horizontal
Venous hum
benign heart finding
- caused by turbulent blood in the internal jugular vein
- Louder in diastole
Best heard: supraclavicular space
Still’s murmur
-Most common benign murmur
-grade 1-2/6, musical, early-mid systolic
Best heard: mid or lower left sternal border (2nd pulmonic, tricuspid)
If abdomen is hard during both inspiration and expiration (should be soft during inspiration) what should you suspect?
peritoneal irritation
What do spider nevi indicate?
liver disease
Diastasis recti
midline separation of the rectus abdominus
Wilms tumor
Wilms tumor = nephroblastoma (kidney!)
- Most common intraabdominal tumor of childhood
- Malignant
What does a sausage-shaped mass in the left or right upper quadrants indicate?
Intussusception
*most common abdominal emergency in children <2 yrs
What does a sausage-shaped mass in the left lower quadrant suggest?
feces in sigmoid colon
Dance sign
right lower quadrant feels empty - movement of cecum from normal position
What is the main reason for sports physicals?
prevent sudden cardiac death
Which 4 sports are more commonly associated with sudden cardiac death?
- football
- basketball
- track
- soccer
Most common cause of sudden cardiac death in athletes?
hypertrophic cardiomyopathy
When does heart reach adult postion?
age 7
Child will have abdominal respirations until age….?
6/7
Which temperature is the gold standard for infants?
RECTAL
Osgood-Schlatter disease
osteochondritis of tibial tubercle
(from repetitive quadriceps contraction leading to subacture fractures or tendon inflammation)
(most common: 9-14)
