PEDS PE Flashcards
What affects how you conduct the medical history and physical exam?
child’s developmental level
Physcial
Cognitive
Social
What are the development levels?
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
Which timefrome do fontanelles closes
Anterior Fontalles- closes 4-26mo
Posteior- closed by 2mo
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
Barlow Maneuver
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
Ortolani Maneuvere
Infant General
0-12= Wt 3x, Ht 50%
Infant General
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
Infant HEENT
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
Infant Lungs
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
Infant CV
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
Infant Male pelvic
cryptochordism
Infant Female pelvic
Breast-2deg to
APGAR
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
Acrocyanosis
peripheral will resolve quickly
Central cyanosis
perioral, mucus
O2 ,85% respiratory disease
Abdomen
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
Barlow
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
Ortolani
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
Nervous system
Mental status
Inspect motor tone
Palpate motor tone through passive ROM of major joints
Cranial nerves
Normal reflexes
Newborn:
Infancy:
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
Early Childhood (1 to 4 years): PE
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
Tips for Examining the Young Child
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
Early Childhood: Unique Physical Examination Feature
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
Cover-Uncover Test
Fixed on an object
Cover one eye- look for strabismus
alignment and subtle strabismus
Monocular and intermittent strabismus
Liver scratch test:
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.
Early Childhood: Unique Physical Examination Features
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
Middle Childhood (5 to 10 years):Physical Examination
Scoliosis
Sexual health
Testicular self exam
Sports screening
Well Child Visits: Schedule
Neonates
Initial birth assessment
2 weeks of life
Infants
2, 4, 6, 9, 12 m
immunization schedule
Well Child Visits: Schedule
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
5-10 yrs
Nose- sphenoid @8, Frontal @ 6-7
Tonsils - 8-16 peaks
Breasts- early as 6y
Tanner Stages Male
Adult full hair
