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Physical Exam 2 Didactic Midterm > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Heart sound that is normal in children?

etiology

best heard

sounds like

A

S3

etiology- Due to rapid ventricular filling

best heard - LLSB, or apex

_sounds lik_e - low pitched early diastolic

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2
Q

pediatric murmur characterized by vibratory, musical buzzing?

heard best?

timing?

A

Stills

Small aortic root/ascending aortic diameter -> high velocity flow across LVOT-ascending aorta

heard best-

  • 3rd intercostal space
  • LLSB
  • apex
  • louder in suprine position

timing- systolic ejection

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3
Q

name benign and malignant pediatric murmurs

A

benign -

S3

Peripheral pulmonary flow murmur (PPS):

Still’s murmur:

Venous hum:

Malignant: VSD

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4
Q

•Soft, hollow, continuous murmur, louder in diastole

heard best?

A

Venous hum:

below R clavicle

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5
Q

pathologic murmur first noticed in newborn

heard best?

diastolic / systolic?

A

LLSB

Short systolic or holosystolic

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6
Q

where are these pediatric murmurs heard best?

S3

Peripheral pulmonary flow murmur (PPS):

Still’s murmur:

Venous hum:

Ventricular septal defect (VSD)

A

S3 -

LLSB,

apex

Peripheral pulmonary flow murmur (PPS):

RUSB or LUSB

Radiates to back & axilla

Still’s murmur:

3rd intercostal space

LLSB

apex

Louder in supine position

Venous hum -

below R clavicle

eliminated lying supine

Ventricular septal defect (VSD) - LLSB

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7
Q

pediatric murmur heard best at

RUSB or LUSB & Radiates to back & axilla

A

Peripheral pulmonary flow murmur (PPS):

Common benign functional murmur

•newborns & infants, Usually disappears by 1 y

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8
Q

venus hum Can be eliminated by

A
  • lying supine
  • changing head position
  • JV compression
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9
Q

Peripheral pulmonary flow murmur (PPS): is caused by

A

turbulence from size discordance of larger main PA-smaller branch PA

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10
Q

stills murmur is caused by

A

Small aortic root/ascending aortic diameter -> high velocity flow across LVOT-ascending aorta

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11
Q

murmur that is Louder in supine position

A

Still’s murmur:

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12
Q

what are the murmurs?

Low-pitched, early diastolic sound

•Mid systolic ejection murmur

Short systolic or holosystolic

Vibratory/musical/buzzing SEM

Soft, hollow, continuous murmur, louder in diastole

A

Low-pitched, early diastolic sound - S3

•Mid systolic ejection murmur - PPS

Short systolic or holosystolic - VSD

Vibratory/musical/buzzing SEM - Stills

Soft, hollow, continuous murmur, louder in diastole - venous hum

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13
Q

what is the best location to hear these murmurs?
venous hum

stills

A
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14
Q

what murmur is the only one that radiates?

where does it radiate?

A

PPS

back & axilla

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15
Q

what are the 2 hip examination maneuvers?

what age are they preformed

A

performed up until 3m of age)

Barlows

Ortolanis

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16
Q

describe Barlow’s test and positive findings

A
  1. flex and ADDUCT the hips by bringing thigh near midline
  2. apply light pressure on knee and direct force posteriorly

positive findings:

femoral head dislocated posteriorly fro acetabulum

dislocation is palpable as head slips out of acetabulum

confirm w/ Ortolani’s test

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17
Q

describe Ortolanis test

A
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18
Q
  • Hip evaluation important to r/o ____?
  • All infants should have serial hip examinations until _____??
A

Developmental Dysplasia of Hip (DDH)

until they are walking

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19
Q

Risk factors for Developmental Dysplasia of Hip (DDH)

A
  • F
  • In utero breech position
  • +FHx
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20
Q

hip special tests according to age

newborns

infants

older

A

newborns (performed up until 3m of age)

•Barlow

Ortolani maneuvers

infants

  • Evaluation of hip abduction -> limited abduction: concerning
  • Evaluation of symmetry of gluteal folds -> asymmetry: concerning
  • Galleazzi test - used to assess for hip dislocation, specifically testing for developmental dysplasia of the hip.

older - Trendelenburg sign (weak hip abductors)

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21
Q

describe galleazi test and what it is udef for

A

infant hip exam: assess for hip dislocation, specifically testing for developmental dysplasia of the hip.

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22
Q

scoliosis assessment

A

Evaluation of shoulder-scapula-hips symmetry w/ pt standing

_Adams forward bend tes_t -> Scoliosis:

•Asymmetrical rise in the thoracic region or lumbar region, or both

scoliometer to test scoliosis degree

•If angle > 7° -> Abnormal -> Ortho- referral

23
Q

abnormal scoliometer finding?

A

angle > 7°

Ortho- referral

24
Q

Tanner staging of pubic hair development in boys

A

Stage I – Prepubertal, no pubic hair

Stage II- sparse, straight pubic hair along base of penis

Stage III – hair is darker, coarser and curlier extending over mid-pubis

Stage IV – hair is adult-like in appearance but does not extend to thighs

Stage V – hair is adult-like in appearance, extending from thigh to thigh

25
Q

Tanner staging of pubic hair development in girls

A

•Stage I – no pubic hair

•Stage II – sparse straight hair along lateral vulva

•Stage III – hair is darker, coarser and curlier extending over the mid-pubis

•Stage IV – hair is adult-like in appearance, does not extend to thighs

•Stage V – hair is adult-like and extending from thigh to thigh

26
Q

Tanner Stages of External Genitalia Development males

A

Stage I – Prepubertal

Stage II- enlargement of testes and scrotum, scrotal skin redness and changes in texture

Stage III – enlargement of penis (length first), further growth of testes

Stage IV – Increased size of penis w/ growth in breadth

  • development of glans
  • testes and scrotum larger and scrotal skin darker

Stage V – adult genitalia

27
Q

what are 2 possible dx seen in pediatric males w/ complaint of scrotal edema

A

hydrocele

hernia

28
Q

hydrocele vs hernia

testicular involvment

reducible

transilumination (+/-)

tx

A

hydrocele

_testicular involvmen_t - YES, Overlies testes & spermatic cord

reducible - NO

transilumination- +

tx - spontanous resolution in 18 mo

hernia

testicular involvment - NO, independent from testes

reducible - YES

transilumination - NO

tx - no spontaneoud resolution, surgical repair

29
Q

what is very important to NOT do in cases of Hypospadias

A

•NO CIRCUMCISION – if need to be repaired they will need the extra skin

30
Q

define & their causes, cross suture lines?

Caput succedaneum

Cephalohematoma

A

Caput succedaneum

Define: Edematous scalp swelling about the periosteum

cause: prolonged engagement of head in birth canal or if vacuum extraction

cross suture line: YES

Cephalohematoma

Define: Subperiosteal blood collection

cause: More common in vacuum or forceps assisted deliveries -> (appears within first 24 hours)

c_ross suture line:_ NO

31
Q

Tx

Caput succedaneum

Cephalohematoma

A

Caput succedaneum - Benign - Resolves in 1 - 2 days

Cephalohematoma - Usually resolves within several weeks

Overall benign, though may develop complications:

  • Calcification
  • ↑risk of neonatal jaundice
  • Infection
32
Q

Cephalohematoma complications

A
  • Calcification
  • ↑risk of neonatal jaundice
  • Infection
33
Q

on inftant head exam define: Tx?

Positional plagiocephaly

Craniosynostosis

A

Positional plagiocephaly - •Flattening of parieto-occipital region

Tx: Resolves w/ time & as infant becomes more active (Increase in “tummy time” helps)

Craniosynostosis: Premature fusion of cranial sutures

  • Skull growth restricted perpendicular to affected suture
  • Compensatory skull growth parallel to affected suture

Tx: surgical reconstruction

34
Q

normal & abnormal findings assoc w/ red reflex

A

Normal:

  • Red/orange color reflected from fundus through pupil
  • Should be symmetric without opacities or spots

If abnormal-> Ophtho- referral

  • Cornea cloudiness = congenital glaucoma
  • Dark light reflex = cataract, retinopathy of prematurity
  • White retinal reflex (leukokoria) = cataract, retinal detachment, chorioretinitis, or retinoblastoma
35
Q

Tanner Staging of Brest Development F

A

•Stage I – prepubertal w/ no palpable breast tissue

•Stage II – development of breast bud, w/ elevation of papilla and enlargement of areolar diameter

•Stage III – enlargement of the breast, without separation of areolar contour from breast

•Stage IV – secondary mound the areolar and papilla project above the breast

•Stage V – resection of areola to match the contour of the breast, the papilla projects beyond the contour of the areola and breast

36
Q

Children can have normal sinus dysrhythmia:

___ HR during inspiration

_____ HR on expiration

A

INC HR during inspiration

DEC HR on expiration

37
Q

Absent or diminished femoral pulses can indicate??

A

coarctation of aorta

38
Q

On first few days of life newborns can have transient murmurs causd by?

A

•closure of PDA

39
Q

Speculum exam CONTRAINDICATED in pre-pubertal child unless…?

A

suspicion for trauma or foreign body

40
Q

differentiate:

Diaper Dermatitis

Candida Diaper Rash

A

Diaper Dermatitis - spares skin folds

Candida Diaper Rash - Involves skin folds & Satellite lesions

41
Q

All infants should have serial hip examinations until they are ___?

A

walking

42
Q

what should always be checked as part of infasnt neuro exam??

abnormal if??

A

Primitive reflexes: part of newborn & infant exam

  • Abnormal if:
  • Absent during neonatal period
  • Asymmetric
  • Persistence beyond age by which should have normally disappeared
43
Q

name the primative reflex

age of appearance

age of resolution

A

Moro

age of appearance - 34-36wks

age of resolution - 5-6 mo

Palmar

age of appearance - 38-40 wks

age of resolution - 5-6 mo

Plantar

age of appearance - 38-40 wks

age of resolution - 9-10 mo

Rooting

age of appearance - 38-40 wks

age of resolution - 9-10 mo

44
Q

what primative reflex should appear by

34-36wks

38-40 wks

A

34-36wks - Moro

38-40 wks -

Palmar

Plantar

Rooting

45
Q

what primative reflex should disappear by

5-6 mo

9-10 mo

2-3 mo

A

5-6 mo - Moro &Palmar

9-10 mo - plantar

2-3 mo - rooting

46
Q

when is Head Control Assessment

normal vs abnormal

A

By 40 wks infant has sufficient neck and truncal strength to maintain some head control

•head in line w/ trunk for one- or two-seconds while being pulled from supine to sitting

abnormal

•Hypotonia – head lags behind as infant is pulled from supine to sitting and continues to lag when sitting position is reached

47
Q

nose exam in newborns focuses on ??

A

•Evaluation of patency of nares in Newborns:

48
Q

Choanal atresia

A
  • Blockage or obliteration of posterior nasal aperture
  • Usually associated w/ bony abnormalities of pterygoid plates of sphenoid & midfacial growth abnormalities
  • If BL atresia - causes respiratory distress immediately after birth
  • Requires surgical repair
49
Q

Newborn OP exam should always evaluate for?

describe technique

A

Evaluate for cleft lip &/or palate:

  • Always visualize till uvula & pharynx
  • Always palpate palate to check for submucosal cleft
  • Bifid uvula may be a normal finding or associated w/ submucosal cleft
50
Q

what is different abour newborn neck exam?

what does neck exam include?

A

Neck is Non-existent!

Clavicle palpation:

Fx of clavicles may occur during birth

Decreased ROM of affected side

Tenderness, crepitus, bone swelling, asymmetric Moro

51
Q

rectal newborn exam includes??

A

•Inspect location & patency of anus

DRE is NOT routinely performed

52
Q

+ Barlow’s and Ortolanis tests

A

+ Barlow - posterior femoral head dislocation

+ Ortolanis - femoral head reduced into acetabulum

53
Q

describe how to perform

barlows

ortolanis

A

barlows - flex and ADDUCT the hip while applying light posterior force to knee

ortolanis - flex and ABDUCT the thigh

Physical Exam 2 Didactic Midterm (4 decks)

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