Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

pediatric physical assessment exam 2 > Peds PA exam 2 > Flashcards

Peds PA exam 2 Flashcards

1
Q

Physical Assessment of Head

A

Look for;
torticollis
examine from above, side, with fingertips, for sutures; Face: forehead and upper orbit, orbitonasal zygomatic area, maxillomand. area, posterior cranial vault

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Macrocephaly Assessment

A 
serial head measures
measure parents head
developmental hx
transilluminate skull
look for skeletal dysplasia
listen for bruit
look for sunset eyes
signs of neurocutaneous disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of Microcephaly

A 
Genetic defect
Karyotype
intrauterine infections
antenatal radiation
exposure to drugs/chemicals
perinatal insult
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Scaphocephaly/Dolichocephaly

A

positional problems in premies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Plagiocephaly

A

common with back head sleep position
no growth perpendicular to sagittal suture
bitemporal narrowing
cranial elongation in anterior-posterior direction
face will be pushed toward affected side
frontal bossing due to pressure on the occiput
ear on affected side will be forward
parallelogram shape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

craniosynostosis

A

rare-skull sutures close and bony plates of skull become fused too early in ilfe
develops while fetus is still in womb
1/2500 births
Sagittal suture closes prem.
Simple or isolated craniosynostosis or complex/syndromal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Brachycephaly

A

b/l coronal or lambdoidal early
broad skull with short base and recessed lower forehead
brachy/turi/acrocephaly is associated with: Apert syndrome, Crouzon syndrome, Pfeifffer syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Crouzon’s Syndrome

A

craniosynostosis most often of coronal and lamboid, sutures
underdeveloped midface w/ receded cheekbones/bulging eyes
Ocular proptosis-which is prominence in eyes due to shallow orbits
Esotropia & wideset eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Apert Syndrome

A 
Ø Very high brachycephalic head
Ø Severe syndactyly affecting all limbs.
Ø Syndactyly involves bony fusion.
Ø Apert is the second most common
craniofacial syndrome after Crouzon.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Oxycephaly

A

closure of all sutures except squamosal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lambdoidal Craniostosis

A

if there is lambdoidal synostis the head can’t expand in frontal region on affected side of the head, so the growth will be affected on unaffected side
growth restriction on affected side»overgrowth everywhere else
Trapezoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Alopecia Areata Vs Tinea Capitis

A

AA:
distrib: patchy, multifocal
onset: abrupt, waxes/wanes
appearance: thin w/ abrupt bare patches, exclamation point hairs
Degree of shed: prominent
age of onset: any, first before 20 usually
other: personal or fam hx of autoimmune, need TSH

Tinea Capitis:
distrib: specific area-focal or multifocal
onset: gradual or abrupt
appearance: none to some inflamm, scaling
age of onset: common in childhood, any
other: contact w/ animal w/ dermatophytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

midface hypoplasia

A

assoc w sleep apnea & stridor
dental problems
maybe hearing problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Micrognathia

A

mandible has not grown asm uch asit should-small mandible and chin
surgical advancement of mandible and chin via intraoral route

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

prognathic mandible

A

lower jaw is too prominent
occurs w/ congenital overgrowth of lower jaw
pahologic such as gigantism due to pituitary overgrowth and other tumors
ex) Jay leno

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sturge Weber Syndrome

A

non elevated purple venous malormation in distribution of trigeminal nerve, opthalmic division
high incidence of dev. delay
ocular complications like glaucoma on affected side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Parotiditis- Types & causes

A

Wind parotiditis: air forced into parotid duct with glandular swelling- when children learn to lay wind instrument or blow balloons

Viral causes: mumps, parainfluenza types 1 and 3, HIV, CMV, coxackie

Bacterial: staphylococcus aureus, streptococcus species
can have tender and red gland w/ significant systemic symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Differential Diagnosis for Parotiditis

A

recurrent parotiditis associated w/ pain & fever
abscess of parotid
rare: cat scratch, TB
metabolic: slow, progressive, painless, no inflammation
starvation-hypoproteinemia, anorexia, cushing
Obstructive enlargement-stones
Autoimmune: lupus w/ recurrent swelling as initial sign, sjogen syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Myopia

A

when anterior-posterior diameter ofe eye is too long relative to refracting power of cornea and lens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

hyperopia

A

eye is too short relative to refracting power of eye. focal point of image occurs posterior to retina and image that forms ont he retina is blurred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Astigmatism

A

refractive eye error that causes blurred vision

when optical system of the eye ( cornea usually) is not perfectly spherical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

strabismus

A

when eyes do not move in synchronous pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Esotropia

A

type of strabismus-inward deviation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

exotropia

A

outward deviation, type of strabismus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

latent strabismus

A

apparent only on dissociation of vvision of the eyes (covering one eye)
phoria-exophoria, esophoria, hyperphoria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

hypertropia

A

misalignment of eyes (strabismus) whereby visual axis of one eye is higher than the fellow fixating eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

hypotropia

A

similar condition, focus being on the eye w/ visual axis lower than fellow fixating eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Esophoria

A

tendency toward inward deviation of eye, usually b/c of extraocular muscle imbalance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

exophoria

A

form of heterophoria-tendency of eye to deviate outward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

comitant strabismus

A

same deviation in all fields of gaze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

incomitant strabismus

A

limited eye movement and size of deviation is different in different fields of gaze
most commonly where there is paralysis of one or more extraocular muscle
Neurological- lesions of 3rd 4th CN from trauma, tumor, infection, ICP

Muscular- direct involvement of muscles
Myasthenia gravis, congenital problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Causes of comitant strabismus

A

hereditary, familial predisposition
sensory deprivation
Accomodative- freqeuent convergence in children who are hypermetropic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Testing for Stabismus

A 
hirschberg/corneal light 
red reflex/bruckner
cover test
evaluate extraocular movement
binocular status-steropsis tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Amblyopia

A

poor vision caused by abnormal dev secondary to abnormal visual stimulation
pressence of associated findings: strabismic amblyopia, anisometropic amblyopia, deprivational amblyopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Strabismic amblyopia

A

results from abnormal binocular interaction

causes fovea of 2 eyes to be presented iwth different images

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Anisometropic Amblyopia

A

fovea are also presented with different images r/t unequal refractive error

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

refractive amblyopia

A

most commonly in hyperopic patients, may occur in patients w myopia or astigmatism as well though

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Deprivation amblyopia**

A

least common and most serious type of amblyopia***

severe visual deprivation due to occlusion of visual axis/distortion of foveal image

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Vision Screening

A

routine screening at age 18 been changed to a risk assessment
visual acuity screen is recommended at ages 4 and 5 years
instrument based screening to assess risk at ages 12 and 24 months
+ well visits at 3-5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

0-6month old vision screening

A

ocular history
vision assessment
external inspection
ocular motility assessment-should fix and follow by 6months
pupil examination
red reflex exam- refer infants with abnormal red reflex or history of retinoblastoma in parent/sibling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

6-12 month screening

A

ocular hx, external inspection, red reflex, pupil exam, ocular motility, visual acuity fixte and follow

wen to refer: infants with strabismus, w/ chronic tearing or discharge
who fail instrument based screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

12mo-3years screening

A

the usual testing + at age 3, start vision screening using optotypes

Refer; who cannot read at least 20/40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

4-5 years old screening

A

usual tests, instrument based screen plus using optotype

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

over 5 years old screening

A

ocular hx, vision assessment, external inspection of eyes/lids, ocular motility assessment, pupil examination, red ref, visual acuity, + opthalmoscopy

Refer: who cannot read at least 20/32 w either eye; must identify majority of optoypes on 20/32 line and those not reading at grade level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Assessing for Ocular motility

A

3-6 feet in front of child
patient follow your giner w eyes- Double H
-check convergence- go in toward patient’s nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Hirschberg test

A

Negative: both reflexes are located .4mm nasal to center of pupil

Positive: if one reflex is located in a position other than .5mm nasal, suspect strabismus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Cover Test

A

watch for flick movements of eye; small angle strabismus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Bruckner/Red Reflex

A

darken room
adjust opthalmoscope so light is not TOO bright
dial to zero
use left hand and left eye to examine LEFT eye; right to right
have patient stare at point on wall
identifies strabismus as well as asymmetric refractive errors
Unequal refractive errors: reflexes will differ in brightness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Pupil Assessment

A

integrity dependes on intact iris, CN II and III, and sympathetic nerves innervating eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Hippus

A

Normal pupil is continuous motion dilating in and out by small contractions
more prominent in pediatric patients exposed to bright light

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Direct & conensual

A

direct- ipsilateral constriction

consensual- flash light in one eye and other pupil reacts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Aniscoria

A

Simple

0.4mm or more difference in size of R and L pupil not related to drugs, ocular injury to inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Relative Afferent Pupillary Defect/Marcus Gunn Pupil

A

most common pupil problems
occurs w/ significant optic nerve or retinal disease & when there’s a difference in disease process between R and L eyes

In Marcus Gunn pupil, the pupil where the light is shined
will constrict strongly when light is shining into the eye
but as light moves to illuminate the abnormal eye, both pupils dilate (react as though the light was dimmer
l The eye that dilates when the light is shown on it, is the
abnormal or Marcus Gunn Pupil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Iris coloboma

A

isolated iris coloboma does not interfere w/ vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Aniridia

A

absence of iris

1/3 associated w/ Wilm’s tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Assessment of Red Eye

A

External inspection of eyes and lids- suspect orbital injury if eye is red at limbus (where iris meets sclera);
-ocular motility, pupil exam, vision screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Ciliary Injection

A

injection at limbus!! Does not spare limbus
lessens as it moves to palpebral conjunctiva
seen in uveitis, keratitis, acute angle glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Chemosis

A

swelling of conjunctiva from allergic conjunctivitis and in kids w/ pharyngoconjunctival fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Subconjunctival Hemorrhage

A

blood under conjunctiva
causes: trauma, sudden increase of pressure in chest
S&S: assoc w/ history of trauma
-if mild and no other sign of ocular injury- benign will disappear in 1 week, no tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

corneal abrasion

A

trauma, foreign body/chemical exposure
S&S:
sensitivity to light, extreme pain, trouble opening eye, tearing, foreign body sensation
dx: area of epithelial defect stains w fluorescein dye and lights up w/ blue light

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Hyphema

A

blood between anterior chamber (space between the iris/cornea)
from trauma, blunt or penetrating; can be assoc w other eye injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Conjunctivitis- bacterial

A

bacterial- H influ, staph, chlamydia

RED, purulent discharge* THE hallmark, swollen lid, one or both eyes

**antibiotic drops do NOT cure gonococcal conjunctiivitis- suspect gonorrhea and send to ER-need IV antibiotis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Viral Conjunctivitis

A

Adenovirus, Herpes simplex, zoster, molluscum contagiosum

S&S- irritation, light sensitivity, swollen lids, watery discharge, some mucous, NOT purulent (distinguishes from bacterial)
often enlarged tender lymph node is present in front of ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Conjunctivitis- Herpes

A

skin vesicles

corneal infection w “dendrite”- hallmark

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Allergic Conjunctivitis

A

environmental allergen, seasonal, sneezing/congestion

Hallmark: ITCH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Blepharitis

A

eyelid inflammation/infection
cause- staph infection at lash base
skin oil glands inflamed

*lice can cause this!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Chalazion

A

obstructed meibomian gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

hyphema

A

layering of blood in anterior segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

hypopyon

A

pus in anterior segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

iridocyclitis

A

inflammation of iris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

iridogonesis

A

quivering of iris when patient moves eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

synechia

A

adhesion between iris and cornea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

conductive hearing loss

A

impairment of outer and or middle ear conductive mechanism only; sound does not make it past the TM. ex) wax build up, foreign object

Screening; Eustachian tube dysfunction, ear fluid, hole in eardrum, fixed middle ear bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Sensory Hearing Loss

A

damage of cochlea (outer hair cells or outer & inner hair cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

mixed hearing loss

A

presence of both conductive and sensory impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

neural hearing loss

A

damage to auditory neurons (spiral ganglia) and / or auditory branch of eith nerve. ex) auditory neuropathy and dysynchrony

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

central hearing loss

A

damage to auditory structures in brainstem, thalamo cortex/cortex.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Early Hearing loss causes

A

maternal rubella, CMV, genetic disorders causing malformation of cochlea, sepsis, o2 deprivation, hyperbillirubinemia
Medications-lasix, aminoglycosides, vanco

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Genetic Syndromes associated with Hearing loss

A

Waardenburg: white forelock and eye abnormalities

Jerveil syndrome, Lange Nielson: deafness assoc w/ long QT –>sudden death! EKG!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Renal Abnormalities

A

kidneys and ears form at same time in utero;

Alport’s syndrome- hearing loss + hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

sensorineural hearing loss- screening

A

noise induced hearing loss
presbycusis
meiniere’s (more adults)
tumors of auditory nerve- Acoustic Neuroma causes sudden progressive loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

External Assessment

A

shape, size, (large: fragile x), symmetry, variations frmo normal
presence of dimples, tags, nodules: remnant of first brachial cleft
position of ear- rotated? should be along straight plan with outer canthus of eye
swelling, drainage, erythema, enlarged pre/post auricular nodes, external otitis w/ cellulitis causes ear to protrude

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Brachial Cyst

A

*pseudomonas smell** distinct odor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Crouzon’s Ears

A

low, rotated backwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

External Otitis Media

A

r/t changes in pH of ear canal
pseudomonas most common
Swimming*- “swimfree” in ears to dry canal
pain on movement of auricle; canal may be red, friable, pus
inspect entire TM for landmarks, color, contour, perforations
tenderness on palpation of tragus is indicative!
tx: antibiotics DROPS (100x stronger) not systemic

86
Q

Otorrhea

A

otitis externa
alteration in acidic pH leads to susceptibility of microbial invasion, severe pain, “fullness” feeling in ear
r/t excessive moisture or cleaning, bacterial, viral, or fungal

87
Q

Tympanic Membrane- What to look for

A

Color- red

Landmarks: are they in the right place? Malleus, borders of TM, light reflex, presence of perforation or fluid

88
Q

Right Ear Landmarks placement

A

Short process of malleus: 1:30

Cone of light reflex: 5:00

89
Q

Left ear Landmarks placement

A

Malleus: 10:30

cone of light reflex: 7:00

90
Q

Color of TM/Significance

A

Amber: serous fluid
blue or deep red: blood in middle ear
chalky white- thick TM indicates recurrent infection
Red- infection,
Dullness- fibrosis
white areas- healed perforations or inflammation or tubes
air bubbles: indicate middle ear fluid

91
Q

Mastoiditis-

A

bacterial infection of mastoid air cells
accumulation of purulent exudate in middle ear- does not drain through ET or perforated TM but instead spreads through to mastoid bone
air cells are destroyed–>progression to coalescent phase: refer to ENT

92
Q

Acute Otitis media organisms

A

bacterial: H influenzae- #1 organism for otitis media
S pneumonia–>meningitis/brain abscess
Group A strep,

Viral: RSV, influenza, mycoplasma pneumonia, fungai

93
Q

Tympanogram: A, B, C

A

Documents Retraction of eardrum
Type A: Normal eardrum movement; -150 to 150 (?)
Type B: indicates little or no eardrum movement, suggesting fluid in middle ear
Type C: middle ear with negative pressure r/t retraction or blockage of ET

94
Q

Nasal Mucosa/Secretions- Color and indications

A

Red inflamed; infection
pale boggy: allergy
Swollen grayish: chronic rhinitis
Purulent secretion:- high up, sinus infection
water secretions indicate: allergy, cold, elicit drug use, rarely skull fracture nasal infections
Foul smelling: FOREIGN BODY

95
Q

Epitaxis

A

typically anterior in origin in childhood; Kiesselbach’s area/plexus

Causes- trauma, inflammation (uri), anatomic (dev septum), vascular abnormalities (hemangioma), malignant neoplasm- (rhabdomyosarcoma, lymphoma), platelet dysfunction (nsaid use, ITP, leukemia, coagulopathy (hemophilia, von willebrand, liver disease), benign masses (granuloma, papilloma)

96
Q

Tx of Epitaxis

A

Digital pressure 10-15 min
Topical vasoconstrictor: Neo-synephrine, Nosebleed QR, Nasal Sponge
Bactroban TID /1 week
posterior bleed–>ENT consult

97
Q

Oral Cavity Evaluation

A

Lips: moist, symmetry, color, breathing, philtrum shape

Buccal mucosa- color, lesion, koplik spots
Gums- color, swelling, bleeding
Tongue, Teeth, palate, pharynx

98
Q

Tonsillar Eval

Grading

A

tonsils enlarge to peak size at 7; then they disappear slowly

Grading:
1+: visible only slightly beyond pillars
2+ if they are midway between pillars and uvula
3+: if are nearly touching uvula
4+: touching midline and occluding view of midline

99
Q

Clinical Presentation of Streptococcal Tonsillitis

A

Nausea, fever maybe only presenting symptom
always examine throat of a child w abdominal pain, esp on right side b/c you can get lymphoid tenderness in right lower quadrant pain
epigastric tenderness and headache are other signs

Scarlet Fever- Pastia’s lines, rash, untreated strept–>toxin causes scarlet fever

100
Q

Peritonsillar Abscess

A

most common deep infection of neck
typical complication of tonsillitis
usually along the tonlsillar pillar; obstruction and infection of Weber gland

101
Q

Sinuses

A

Maxillary: Present at birth; rapid growth from birth-4 years and then 6-12

Frontal- last to develop

Ethmoid- present at birth but not developed, grow during first 4 years, fully by 12

Sphenoid- underdeveloped at birth, doesnt grow til after 5

102
Q

Goiter

A

enlargement of thyroid

103
Q

thyroid nodules

A

nodules in children need referral to endocrine to see if need to biopsy; more often in females
some have higher risk of cancer, esp if history of radiation therapy –risk of thyroid disease

104
Q

cystic hygroma

A

1 in 12,000 births
multioculated cystic lymphatic malformation usually found by age 2
2:1 left sided
discrete, soft, mobile, nontender, in posterior triangle
can cause trachial compression and stridor–>airway
usually dx in utero–>ENT consult
collection of lymph sacs with clear, colorless fluid
late presentations often follow viral infection

105
Q

Second Brachial Cleft Cyst

A

most common congenital neck mass-2-3%
smooth, n/t, fluctuant masses occur along lower 1/3 of anteromedial border of sternocleidomastoid
“pencil point,” protruding from lower part of sternoclidomastoid
can get infected–>must be removed

106
Q

Thyroglossal Duct Cyst

A

usually below level of hyoid bone in midline or off center
seen best when neck is hyperextended
may rise with tongue protrusion and swallowing b/c can be connected to base of tongue, or connected to diaphragm
assoc w high incidence of thyroid carcinoma in adulthood
must be removed- can be only thyroid tissue so sometimes will develop hypothyroidism after removal

107
Q

lymphadenopathy

A

enlargement of lymph nodes by proliferation of normal cells or infiltration of abnormal cells
-less common than localized adenititis
sign of underlying infection or systemic disease

Major causes
Medications (Cephecor)
Malignancy
autoimmune (juvenile arthritis, lupus)

108
Q

anatomy of lymph node

A

bean shaped
covered with capsule
2 basic parts:

cortex- populated with lymphocytes- B and T cells and
Medulla- made up of macrophages

109
Q

Reassuring Cervical lymph nodes

A

tender on PE

110
Q

Worrisome/Malignant Lymph nodes

A

more than 2cm and firm and matted

ex) Epitrochlear on radial side of elbow- enlargement is never benign

111
Q

Normal Sizes of Nodes

A

Cervical and axillary: up to 1 cm
inguinal: up to 1.5 cm
Epitrochlear: up to 0.5cm

> 2cm–>malignant!!

112
Q

Shotty node

A

freely moveable along sternocleidomastoid anterior

113
Q

Anterior triangle of neck

A

bound superirorily by mandibular border and extends along sternocleidomastoid muscle to mid line of neck: Reactive Adenopathy from infection

114
Q

posterior triangle

A

enlargement of posteior nodes are 50% malignant adenopathy

-others aoften from lice; worrisome of no infection present

115
Q

Reactive adenopathy

A

reaction to an infection in drainage area

ex) pharyngitis, otitis media, conjunctivitis (which causes swelling in preauricular node!)

116
Q

Lymphadenitis

A

the node itself is infected
inflamed, enlarged, tender
acute onset
associated with tender erythematous warm lymph nodes and fever
need ultrasound to see if it needs to be drained (is there an abscess?)

117
Q

Cleidocraniodyostosis

A

no collar bones or abnormally developed; jaw and brow protrudes, wide nasal bridge (shoulders touch together in front of body); delayed closure of fontanelles

118
Q

Blaschkow’s lines

A

pigment differences between the front and back

inoontinenti pigmenti- swirls on the skin- can be swirls in brain as well that can lead to seizures

119
Q

Single Gene Disorder

A

mutation in single gene causes a disorder
Ex) Marfan, neurofibromatosis (DOMINANT)
ex) CF, sickle cell, tay sach (RECESSIVE)
X linked- Duchenne Muscular Dystrophy

Testing: Micro array, DNA sequencing, deletion testing

120
Q

Triplet Repeat Disorder

A

Trinucleotide repeats in certain genes
results may be interference of normal gene or gene product
ex) Fragile X, huntington,

121
Q

Variable Penetrance

A

how gene is expressed; factors that influence the effect on particular genetic changes

122
Q

VATERL Associations

A 
Vertebral anomalies
Anal atresia
Cardiac anomalies
Trachea-esophageal fistula
Esophageal atresia
Renal anomalies, dysplasia
Limb anomalies
Single umbilical artery (instead of 2)
123
Q

CHARGE associations

A 
C-coloboma
H-heart defects
A-atresia choanal
R-retardation of growht and development
G- genitourinary problems
E-ear abnormalities
124
Q

Goldenhar Symdrome

A

affects one side of the face only
partially formed or absent ear (microtia)
chin maybe closer to affected ear; one corner of mouth may be higher; benign growths of eye, missing eye
other: cleft lip/palate, hearing loss, vertebral anomalies, kidney/heart problems***
missing dentition, lack of facial development

125
Q

Minor Anomaly

A

occurs in less than 4% of population most often in face and hands
normal phenotypic variant is > 4%
ex) crease in asian children

But can be associated as markers for occult major malformations** ex) sacral tuft or dimpling- spina bifida
specific minor abnormalities of face hands and feet- Down’s

3 or more minor anomalies increased risk of major malformation

126
Q

Brachycephaly

A

closure of bilateral coronal or lambdoidal sutures

asymmetrical head or face, flat occiput, fontanels too large or too small, overlapping sutures

127
Q

Micrognathism

A

small mandible

128
Q

retrognathism

A

receding mandible

129
Q

prognathism

A

projection of jaw beyond forehead-jay leno

130
Q

Ocular hypertelorism
Vs
Hypotelorism

A

widespread eyes

eyes are close together

normal- about one eye length between the 2

131
Q

Telecanthus

A

lateral displacement of inner canthi causes more space between the eye and nose on one side than the other

132
Q

fused eyebrow is associated with

A

cornelia de langue

133
Q

Asymmetrical Crying Facies

A

higher incidence of congenital heart disease- VSD, ASD, PDA, Tet

134
Q

What are different colors within one iris associated with?

A

retinal blastoma

135
Q

Palpebral Fissures

A

normal: horizontal or upword with an angle of less than 10 degrees
Upward is > 10 degrees
downward: external canthus is lower than internal

136
Q

Wilson Disease

A

Kayser fleischer rings- deposition of copper in cornea; brownish/greenish ring
severe liver cirrhosis, neurlogical symptoms, psych symptoms
Do a serulomplasim
Copper metabolism disorder
urine test, blood test, liver function

137
Q

Shallow philtrum associated with

A

Fetal alcohol syndrome

138
Q

Waardenburg Syndrome

5 major diagnostic criteria

A

1) Sensorineural hearing loss
2) Iris pigmentary abnormality (two eyes diff color or iris bicolor or brilliant blue iris)
3) hair hypopigmentation (forelock or white hairs elsewhere)
4) Dystopia canthorum (lateral displacement of inner canthi)
5) first degree relative with Waardenburg

Minor criteria- beak nose, hypoplasia nasi, premature graying of hair, medial eyebrow flare

139
Q

Myotonic Dystrophy

A

Myotonia- cannot relax the muscle, continuous contraction of the muscle
cheshire cat smile
appear with drooping eyes/face, muscle wasting, cataracts

140
Q

syndactaly

A

joining of hte fingers or toes

141
Q

clinodactyly

A

curved fingers

142
Q

positive thumb sign

A

connective tissue disorder- thumb sticks hwen you make a fist out b/c its long, narrow, tapered

143
Q

gynecomastia

A

enlarged male breast

144
Q

pectus excavatum

A

sunken in chest

145
Q

pectus carinatum

A

pigeon shaped chest, protrudes

146
Q

ash leaf is associated with

A

tuberous sclerosis

147
Q

Struge weber associated with

A

glaucoma and red mark on part of face

148
Q

coloboma

A

abnormal pupil- can be retina or iris

149
Q

cherry red spot in macula of retina is associated with

A

Tay Sach’s

150
Q

Ectopia Lentis

A

displacement of lens- abnormal flat cornea, increased axial length of the globe, hypoplastic iris
seen in Marfan’s

151
Q

rocker bottom feet are associated with

A

Trisomy 18

curved bottom foot

152
Q

Location of PMI

A

Should be at 5th intercostal space, right of nipple line

if it is on the left of the nipple, can be a large heart

153
Q

Cardiac Evaluation- HISTORY

A

exercise tolerancevery important- fatigue is sign of low ejection fraction
feeding difficulty
dizziness or syncope
perinatal history
Maternal History
use of NSAIDS or ASA cause premature closure of ductus arteriosis
Use of Lithium leads to tricuspid valve anomaly
DM- Cardiac renal anomalies
Alcohol and drug use- VSD, ASD

154
Q

Teratogens and Heart disease & malformations

A 
Alcohol- 25-30%CHD and ASD,VSD, PDA
Lithium-10% CHD, Ebstein, ASD
Rubella 35% CHD, PPS, PDA, VSD, ASD
Maternal DM- 3-5% CHD? 30-5)%
Lupus- 50% CHD, assoc w HEART BLOCK
155
Q

Number one cause of myocarditis is

A

Enterovirus

156
Q

Syncope + exercise=

A

Cardiomyopathy-NO SPORTS; electrical activity is affected

157
Q

rapid breathing with SOB and colicky baby suggets

A

Heart Failure

158
Q

BP is higher in the

A

legs

159
Q

ALL THAT WHEEZES IS NOT ASTHMA

A

Lungs- if wheezing, could indicate cardiac problem

160
Q

Assessment and Pulse

A

pulse rate increase by 10-15bmp for each degree of fever

Premature babies have bounding pulses because of lack of subcut fat and higher incidence of PDAs

161
Q

Bounding Pulse is a sign of __ and heard best __

A

Patent Ductus Arteriosis, heard at 2nd intercostal space under clavicle in pulmonic area

162
Q

Palpation technique for thrill

A

turn child to left and feel at apex
basal thrills felt with child sitting up
thrills- look at PMI and suprasternal notch

high frequency thrills along left border- VSD
low frequency thrill in 2nd ICS-aortic stenosis
Diastolic Thrill at apex- Mitral stenosis

163
Q

angle of louis

A

to the right-aortic space

to the left- pulmonic space

164
Q

Situs inversus

A

complete anatomy reversal; cilia in nose brush thigns inward instead of out–>recurrent sinusitis

165
Q

Kartegener Syndrome

A

reversal of cilia and is associated with transposition of great vessels

166
Q

Auscultation ares

A

Aortic, mitral, Erb’s (common for innocent murmurs), Tricuspid, pulmnic
+infraclavicular- carotid and axillary
and posterior under sapula

167
Q

What is heard best under scapula on posterior

A

Coarcation of aorta

168
Q

what is heard best below clavicle

A

PDA

169
Q

7 S’s of innocent Murmurs

A

1) Systolic
2) Short duration (not holosystolic)
3) single (no clicks or gallops)
4) small ( does not radiate)
5) sensitive (tend to change with position or respiratory effort- louder supine)
6) soft
7) sweet- no harsh sounds

170
Q

S1

A

closure of tricuspid and mitral valve

best heard at left lower sternal border or apex

171
Q

splits in s1

A

can be norml in children but if are wide can be right bundle branch block/Ebstein anomaly

172
Q

s2

A

closure of pulmonic and aortic valve

best heard at base of heart

173
Q

if split varies with respiration, this is

A

abnormal

174
Q

if there is no preop murmur, then there is a post op murmur

A

bleeding out!

175
Q

Murmurs

A

produced when blood velocity because critically high in presence of narrowing or irregularity
leads to turbulence which produces a sound

176
Q

pregnant women have murmurs because of

A

physiological anemia

177
Q

Systolic Murmur

A

1) Ejection- short ejection murmur is common

2) holosystolic or reguritant

178
Q

Diastolic Murmurs

A

Diastolic murmurs are never normal!!

1) early decrescendo
2) mid diastolic

179
Q

Grading Murmurs

A

1/6: Faint, not easily heard; comes after a few seconds
2/6: faint but heard immediately
3/6: loud but no thrill
4/6: loud with thrill
5/6: loud with thrill and herd at edge of stethoscope on chest
6/6 heard with stethoscope 1cm off chest wall

180
Q

Third Heart Sound

A

associated with ventricular filling
louder in noncompliant left ventricle
louder with increased BF/CO
intermittent s2 may be normal variant

181
Q

Chest X-Ray- Tetrology of Fallot

A

BOOT sign

182
Q

Chest Xray- transposition of great artiers

A

egg on a string sign

183
Q

chest xray- pulmonary venous connection

A

snowman sign

184
Q

chest xray- partial anomalous Pulmonary Venous Return

A

scimitar sign

185
Q

5 Innocent Murmurs of childhood

A 
Still's murmur
Pulmonary flow murmur
Peripheral pulmonic stenosis murmur
Supraclavicular bruit
Venous hum
186
Q

Still’s murmur

A

froo uniform periodic vibration of left heart structure
first heard during sick visit in preschool, disappears by puberty
most common innocent murmur**
soft, twangy sound, vibratory,
lower Left sternal border
louder supine
decreases significantly or disappears with Valsalva
3-7year olds

187
Q

Pulmonary Ejection Flow murmur

A 
15%
11-13 year olds most commoonly
short, systolic ejection
upper Left sternal 
louder with expiration*
Normal S2 split
thin, tall bodies
straight back
increase CO
increases with supine position
increases with fever, anemia; varies from 1-3/4 grade
best heard supine with exhalation
188
Q

Peripheral pulmonic branch stenosis

A

*neonates!
usually disappears by 6months
–if it does not disappear, is assoc with Williams syndrome and congenital rubella
newborn infants, well child visits heard in axillary

189
Q

Supraclavicular Carotid Bruit

A

turbulence at take off area of brachiocephalic and carotid arteries from aortic arch
systolic and ejection, HIGH pitched, Harsh
does not radiate
best heard supraclavicular fossa on right
when you hyperextend shoulders-it goes away

190
Q

Venous Hum

A 
continuous
supraclavicular
right more than left
disappears with head position change
loudest sitting or standing
191
Q

Wide Split S2 indicates

A

ASD

192
Q

if PMI is at left of nipple

A

heart is possibly enlarged-should be on right

193
Q

if BP is lower in the legs than arms, this indicates

A

coarcation of aorta- heard best on back below scapula

194
Q

Aortic stenosis

A

5% of children with CHD
may also have coarct, VSD or PDA
non obstructive, isolated bicuspid aortic valve is most common congenital defect, 1% of population
presents: murmur, loud

can be valvar, sub or supra valvar

195
Q

pulmonic stenosis

A

systolic ejection murmur
upper left sternal border
radiates to back
click at sternal border varies with respiration

196
Q

PDA Presentation

A

should close within 48 hours
blood from right ventricle into descending aorta, bypasses lungs
direction of shunting depends on differential resistance between aorta and pulmonary artery

Prematurity-pulmonary overcirculation and present early
infants and kids can be asymptomatic
single s2= pulmonary HTN
Wide Pulse Pressure* 
Bounding Pulses* 
Quincke pulse on finger tips
Large PDA + ASD-->STROKE risk
197
Q

coarctation of aorta

A

narrowing of aortic arch adjacent to ducturs
heard below left scapula**
decreases pulse and BP in lower extremities
often assoc w bicuspid aortic valve
can be pre or post ductal
HTN, heart failure and FTT without repair*

198
Q

VSD

A

holosystolic murmur
high pithed, harsh if it is small
Diastolic rumble at apex

increased work of breathing , inc LA pressure, pulmonary edema, poor growth
leads to pulm HTN if unfound

must repair by age 1
can have normal-wide split S2 will vary with respirations
increase volume traversing pulmonary valve, causes it to close later
loudness of murmur does not correlate with size of defect

199
Q

ASD

A

upper L sternal border
wide fixed split S1
subtle exercise intolerance
fatigue!

200
Q

what causes diastolic murmurs?

A

turbulence in ventricular inflow- narrowing, increased flow, semilunar valve regurg

201
Q

what causes continuous murmurs

A

abnormal systemic to pulmonary artery communications
PDA
AV fistula or coronary artery fistula

202
Q

Abnormal Murmurs in first days of life

A

outflow obstruction murmurs: AS, PS, Coarc

abnormal communication: VSD, PDA

203
Q

Why do infants present with tachycardia

A

the cannot increase stroke volume, so they increase the rate to increase output

204
Q

Hypertrophic Cardiomyopathy**

What maneuvars increase intensity of this murmur?

A

listen while squatting and then have them stand; murmur will INCREASE in intensity with standing!

-strain of valsalva decreases preload
exercise increase contractility
standing suddently decreases afterload
—»increase intensity of hypertrophic mumur

205
Q

What maneuvers will decrease the intensity and duration of this movement? Opposite of what you’d think!

A

Squatting or hand grasp- DECREASES murmur

Raising legs- Decreases murmur

206
Q

Chest Pain in children- differential dx

A

Musculoskeletal-costochondritis, pain with deep breath
Respiratory conditions- cough, PE, OCP use? leg trauma
Psychogenic- anxiety
GI disorders- GERD, foreign body, hiatal hernia
Cardiac Disease-myocardial ischemia, anomalies, see card
Idiopathic-20-45%

207
Q

chest pain- cardiac disease causes

A 
Myocardial ischemia- coronary anomalies
Kowasaki
cocaine, drugs
arrythmias
hypertrophic cardiomyopathy
marfan- aortic dissection!
Pericarditis- pt will not lean backward, want to learn forward
208
Q

Aortic Dissection

A

Emergency
acute and sharp pain
anterior chest or back
Marfan Syndrome and Ehler’s Danlos

209
Q

Pericarditis

A

severe substernal chest pain
won’t lean backward!!
pain is reproduced by sternal pressure
consider in post op cardiac pts

210
Q

When to refer chest pain

A

with or after exercise, with syncope or near syncope, pain in patient with previous cardiac disease or surgery, or acute, sudden onset in marfan’s

211
Q

Kawasaki Disease

A

vasculitis, young children (

212
Q

Kawasaki Disease Dx

A

Fever for at least 5 days
and at least 4/5 features:
1) changes in extremities-edema, erythema, desquamation
2) Polymorphous exanthem, usually truncal
3) Conjunctival injection that SPARES LIMBUS
4) Erythema and/or fissuring of lips and oral cavity
5) Cervical lymphadenopathy
and illness cannot be explained by other disease process
can have strawberry tongue
peeling hands!

pediatric physical assessment exam 2 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions