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SMUPAFall-PD Lecture > PEDS PE > Flashcards

PEDS PE Flashcards

1
Q

What affects how you conduct the medical history and physical exam?

A

child’s developmental level
Physcial
Cognitive
Social

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2
Q

What are the development levels?

A 
Newborn (birth to 1 month)
Infancy (1 to 12 months)
Early childhood / Toddler (1 to 4 years)
Middle childhood (5 to 10 years)
Adolescence (11 to 20 years)
Early
Middle
Late
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3
Q

Which timefrome do fontanelles closes

A

Anterior Fontalles- closes 4-26mo

Posteior- closed by 2mo

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4
Q

Test for ability to sublux or dislocate an intact but unstable hip
If you feel the head of the femur slipping out onto the posterior lip of the acetabulum, this is a positive Barlow sign
Concerning for hip dysplasia from laxity at hip joint

A

Barlow Maneuver

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5
Q

Test for posteriorly dislocated hip
With hip dysplasia you feel a “clunk” as the femoral head enters the acetabulm; palpable movement of the femoral head back into place is a positive Ortolani sign

A

Ortolani Maneuvere

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6
Q

Infant General

A

0-12= Wt 3x, Ht 50%

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7
Q

Infant General

A

Temperature
<2 months of age: rectal temperature
≥ 2 months of age: tympanic temperature
Blood pressure – start measuring at age 3
Calculate BMI (body mass index) starting at age 2
Skin (throughout the exam)
Vernix caseosa: present at birth
Lanugo: shed within the first few weeks of life

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8
Q

Infant HEENT

A 
Eyes-same
Ears- patency of ear canal
Acousti blink reflex
Naseal- nasal breathers 2mo
ethmoid present only
Tooth-6-26m, 1 tooth per mo
Neck-ROM
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9
Q

Infant Lungs

A 
Tactile if infant is crying
NO percussion-thorax is round
Louder sounds
Upper is louder coarse w/ inspirations
Lower lobes- loudest over site of pathology
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10
Q

Infant CV

A

Cyanosis
Brachial and femoral pulses
S1,S2 splits normal (rapid v filling, heart disease)
S3 normal (after S2 atria contracting)
Murmurs 50% Pathologic- muscical diastolic

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11
Q

Infant Male pelvic

A

cryptochordism

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12
Q

Infant Female pelvic

A

Breast-2deg to

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13
Q

APGAR

A 
1min 8-10 ideal
5min 8-10 ideal
Heart Rate
Respiratory Rate
Muscle Tone
CNS irritabilty
Color

1 min0-4-CNS, resuscitation
5-7 some CNS depression

5min
High risk CNS or organ system

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14
Q

Acrocyanosis

A

peripheral will resolve quickly

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15
Q

Central cyanosis

A

perioral, mucus

O2 ,85% respiratory disease

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16
Q

Abdomen

A

Inspect – umbilical cord remnant is gone by 2 weeks of age
Auscultate bowel sounds
Palpate - liver edge 1-2 cm spleen tip is normal
Rectal – generally not done
Umbilical- normal disappear 1yr

17
Q

Barlow

A

ability to sublux or dislocate an intact but unstable hip
If you feel the head of the femur slipping out onto the posterior lip of the acetabulum, this is a positive Barlow sign
Concerning for hip dysplasia from laxity at hip joint

18
Q

Ortolani

A

Test for posteriorly dislocated hip
With hip dysplasia you feel a “clunk” as the femoral head enters the acetabulm; palpable movement of the femoral head back into place is a positive Ortolani sign

19
Q

Nervous system

A

Mental status
Inspect motor tone
Palpate motor tone through passive ROM of major joints
Cranial nerves

20
Q

Normal reflexes
Newborn:
Infancy:

A

Palmar grasp, plantar grasp, moro reflex (Startal-ABnormal persisten 4M), asymmetric tonic neck reflex, positive support reflex, anal reflex, positive Babinski-
ABSENT or DIMINISHED

Triceps, brachioradialis, and abdominal reflexes present starting at age 6 months

21
Q

Early Childhood (1 to 4 years): PE

A

slows to 50%
child seated – examine the eyes, palpate neck, percuss/auscultate

supine position – examine abdomen, musculoskeletal, nervous system; examine genitalia last

patient upright; look at the throat and ears

Talk to them through exam and parents

22
Q

Tips for Examining the Young Child

A

ask the child which body part he or she would like to have examined first

Examine the child in the parent’s lap; allow the parent to undress the child

If unable to console the child, allow a short break
Make a game out of the examination

23
Q

Early Childhood: Unique Physical Examination Feature

A

Vital signs:
BP @ 3
Neck: lymph nodes; adenopathy is common

Eyes: Cover and uncover test
Red reflex

Ears:
Visualization of tympanic

Nose/sinuses:
Maxillary sinuses age 4

Oral Exam-Save for last

Heart-Brachial pulses easier
Murmur: vibratory, musical

Abdomen
Protuberant abdomen still normal, Liver span, Spleen edge

Use the scratch test to palpate for the liver size
1-2 cm below costal margin is normal

24
Q

Cover-Uncover Test

A

Fixed on an object
Cover one eye- look for strabismus

alignment and subtle strabismus
Monocular and intermittent strabismus

25
Q

Liver scratch test:

A

After placing a stethoscope over the approximate location of a patient’s liver, scratch the skin of the patient’s abdomen lightly, moving laterally along the liver border. When the liver is encountered, the scratching sound heard in the stethoscope will increase significantly. In this manner, the size and shape of a patient’s liver can be ascertained.

26
Q

Early Childhood: Unique Physical Examination Features

A

Male genitalia:
Testes undescended in scrotal sac by age 1 is abnormal and need to refer
Musculoskeletal system:
Knock-knees from 18 months to 4 years of age
spine for scoliosis in any child who can stand

27
Q

Middle Childhood (5 to 10 years):Physical Examination

A

Scoliosis
Sexual health
Testicular self exam
Sports screening

28
Q

Well Child Visits: Schedule

A

Neonates
Initial birth assessment
2 weeks of life

Infants
2, 4, 6, 9, 12 m
immunization schedule

29
Q

Well Child Visits: Schedule

A

Children
15 & 18 mos

Annually from 2-5 years

Every 1-2 years from 6-10 years
Adolescents

Every 1-2 years
11-12 yo visit is important for vaccines

30
Q

5-10 yrs

A

Nose- sphenoid @8, Frontal @ 6-7
Tonsils - 8-16 peaks
Breasts- early as 6y

31
Q

Tanner Stages Male

A

Adult full hair

SMUPAFall-PD Lecture (7 decks)

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