Physical Exam Flashcards
Newborn
birth-2mo
Infant
0-1yr
- neonatal: 1-28 days
- postneonatal: 29 days-1 year
Toddler
1-2yr
Child
2+ years
What is the purpose the Apgar Score?
assess neurologic recover from birth and adaptation to extrauterine life
What are the components of the Apgar score?
- heart rate
- respiratory effort
- muscle tone
- reflex irritability
- color
What does Apgar stand for?
- Activity
- Pulse
- Grimace
- Appearance
- Respiration
What is a normal Apgar score at 1 minute?
8-10
An Apgar score of ___ indicates some nervous system depression.
5-7
An Apgar score of ___ indicates severe depression requiring immediate resuscitation.
0-4
What is a normal Apgar score at 5 minutes?
8-10
Preterm
<37 wks
Term
37-42 wks
Postterm
> 42 wks
Preterm Appropriate for gestational age infants are more prone to…
- respiratory distress syndrome
- apnea
- patent ductus arteriorsus
- infection
Risks for Large for gestational age infatns
- birth difficulties
- metabolic abnormalities shortly after birth
What is a risk factor for an infant to be LGA?
maternal diabetes
Newborn Exam sequence
- observation
- head, neck, thorax, abdomen, genitourinary system
- LE, back
- ears, mouth when open
- skin, as you go
- neurologic system
- hips
What is paradoxic breathing?
when the chest moves inward during inhalation instead of expiration
What is the Flush Technique?
a way to measure BP in infants
==>empty vessels and release pressure slowly until arm “flushes” to usual color
What happens if the cuff is too wide or too narrow?
wide: underestimate BP
narrow: artificially high BP
What are the most accurate temperature readings in a newborn?
rectal or axillary
==> children >5 inc axillary reading by 1 degree
How should you measure an infant?
from top of head to heel with the foot dorsiflexed
When is the head circumference taken?
every “health visit” yoa
What is measured for head circumference?
largest circumference
==>glabella to EOP
Where do you measure chest circumference?
measure around the nipple line to the nearest 1/8th
Breastfed infants correlate more with ___ growth rates.
WHO
Formula infants correlate more with ___ growth rates.
CDC
What is the average birth weight?
5lbs 8oz- 8lb 13oz
What is the average length at birth?
18-22 in
What is the average birth head circumference?
13-14 in
How much does length increase within the 1st year of life?
50%
What are the weight increments in the first year?
double by 6 months
triple by 1 year
Head & chest circumference newborn to 5 months
head may equal or exceed chest by 2cm
Head & chest circumference 5 months to 2 years
chest should closely approximate head
Head & chest circumference > 2 years
chest should exceed head
Growth patterns: infancy
- trunk predominates
- fat inc until 9mo
Growth patterns: childhood
- legs grow faster
- slow fat until 7 prepubertal fat
Growth patterns: adolescence
- trunk and legs elongate
- 50% ideal weight gained
- skeletal mass and organs double in size
What is primary hydrocephalus?
sutures do not close
What is secondary hydrocephalus?
brain does not grow
Transient mottling when infant is exposed to dec temperature
cutis marmorata
When should an underlying cardiac defect be considered with the presence of acrocyanosis?
if it is persistent or more intense in the feet than hands
vernix caseosa
- mixture of sebum and skin cells
- protective
Flat, deep pink patch seen in back of neck
telangiectatic nevi
“stork bite”
Irregular areas of blue/gray pigmentation usually in sacral/gluteal regions
dermal melanocytosis
Pink papular rash with vesicles superimposed
erythema toxicum
-inability of the liver to get rid of toxins
When does jaundice become worrisome?
if it descends below the nipples (>12 mg/dl)
Physiologic Jaundice
-
- inability of liver to conjugate bilirubin
- present in 50%
- disappears in 8-10 days
What is the most likely cause of nail clubbing?
cardiovascular disease
What technique is used to check for nail clubbing?
Schamroth Technique
What are milia?
- small, white papules on face
- plugged sebaceous glands
What is miliaria?
- heat rash
- occlusion of sweat ducts
Where is eczema MC seen in younger children?
FACE, elbow, knees
Faun tail nevus can be associated with ___?
spina bifida occulta
What can facial port-wine stain be associated with if it involves the ophthalmic division of CN V?
Sturge-Weber Syndrome
Postauricular and occipital lymph nodes are common up until what age?
2 years
Cervical and submandibular lymph nodes are common at what age?
after 2 years
What are the MC symptoms for Mono in children?
fever, HA, tummy ache with the absence of a cough
Subcutaneous edema that crosses suture lines, is soft and is MC seen in the occiput or presenting part?
Caput Succedaneum
Subperiosteal bleed that does not cross suture lines, is firm and is MC seen in the parietal region?
Cephalhematoma
What is the MC type of craniosynostosis?
sagittal synostosis (most rare = lambdoid)
What are some characteristics of lambdoid synostosis?
- flattening of affected side
- inc. ipsi mastoid growth
- ear migrates back on affected side
Posterior fontanel closes by ___?
2 months
Anterior fontanel closes by ___?
24 months
How large should the transillumination ring be in all regions of the head?
<2cm
occiput = <1cm
Setting sun sign is seen in what condition and what it the cause?
Hydrocephalus
==>paresis of superior rectus muscle
Craniotabes can be associated with which conditions?
- rickets
- hydrocephalus
- premature infants
What are some characteristics of Fetal Alcohol Syndrome?
- smooth philtrum
- widespread eyes
- hirsute forhead
- short nose
- thin upper lip
What is Hypertelorism?
widely spaced eyes
==>may be associated with mental retardation
What are Brushfield spots?
small gray specks in a circular pattern in the iris; associated with Down’s syndrome
In a cross-cover test, you expect the exotropic eye to move ___?
lateral to midline
In a cross-cover test, you expect the esotropic eye to move ___?
medial to midline
In a cross-uncover test, you expect the exotropic eye to move ___?
lateral
In a cross-uncover test, you expect the esotropic eye to move ___?
medial
What is Amblyopia?
reduced vision in an eye that appears structurally normal
What is Duane Syndrom?
-congenital non-progressive horizontal ophthalmoplegia due to agenesis of abducens nucleus
A Snellen result of what may indicate amblyopia in a child?
2 line difference between eyes
Congenital Cataracts requires what type of workup(s)?
- metabolic
- infectious
- systemic
- genetic
What are some common causes of congenital cataracts?
- TORCHS
- hypoglycemia
- trismoies
- prematurity
Retinopathy of Prematurity increases the risk of?
- retinal detachment
- glaucoma
- blindness
How does the external auditory canal differ in an infant compared to an adult?
it is shorter and has an upward curve
pull downward
The tip of the auricle should line up with which two landmarks?
outer canthus and EOP
What is the MC infection of the middle ear in children?
bacterial otitis media
What are some long term issues with chronic otitis media w/effusion?
delayed speech development
Which sinuses are the first to develop?
maxillary and ethmoid
When does the frontal sinus develop?
by 7-8 years
What is the MC symptom in a 3 year old with a sinus infection?
bad breath
Why should you not use a tongue depressor in an infant?
stimulates “tongue thrust reflex”
Which teeth normally come in first?
front lower incisors
Complete cleft palate includes which structures?
lip, hard palate, soft palate and into nasal cavity
What is a peritonsillar abscess?
infection of the tissue between tonsil and pharynx
What should you not use on a child that has epiglottitis?
tongue depressor b/c it can trigger more muscle spasms
When is epiglottitis MC?
3-7 years of age
What are some characteristics of epiglottitis?
- sudden high fever
- drooling
- tripod position
- sore throat
What could be indicative of a relatively larger chest circumference?
poorly controlled gestational diabetes
If chest roundness persists after 2 years of age, what should you suspect?
chronic obstructive pulmonary problem
==>cystic fibrosis (MC)
==>chronic asthma
Autosomal recessive disease of exocrine glands
cystic fibrosis
What is the normal distance between the nipples?
1/4 of the chest circumference
What is the average respiratory rate in an infant?
40-60 rpm
What are some indicators of increased respiratory effort?
- retraction of supraclavicular notch
- SCM contraction
- flaring of nostrils
- intercostal retractions
- tachypnea
What is laryngomalacia?
when the cartilage of the larynx is not fully developed = “floppy”
What is the MC causes bronchiolitis?
respiratory syncytial virus (RSV)
When is bronchiolotitis MC?
<6 months
When is croup MC and what gender does it MC affect?
1 1/2 - 3 years; boys
parainfluenza virus
During what part of the day does croup come on?
at night after child has gone to sleep
How long after birth does the foramen ovale and ductus arteriosus close?
24-48 hrs
What is characteristic of a patent ductus arteriosus?
machinery murmur
What is a potential complication of a patent ductus arteriosus?
right sided heart failure
fatigue, no cyanosis
What is a finding commonly found in infants with congestive heart failure?
an enlarged, firm liver
Which heart condition will always cause cyanosis at birth?
transposition of the great vessels
What is the normal capillary refill time in a newborn?
<1 second
prolonged = >2 sec.
(dehydration, hypovolemic shock)
How do you determine amplitude and pulse count in an infant?
palpate apical impulse for amplitude and listen for pulse count
What are some conditions that can shift the apical impulse?
- pneumothorax
- diaphragmatic hernia
- dextrocardia
What is sinus invertus?
heart and stomach are on the right, liver on the left
What are some causes of a weak or thin pulse?
- decreased CO
- peripheral vasoconstriction
What are some dDx for a bounding pulse?
L to R shunt (PDA)
What is a dDx for a difference in pulse amplitude between femoral and radial?
coarctation of the aorta
How much does HR increase with temp. increase?
10-20 beat inc. for each degree inc
What are the 4 “S’s” for Innocent murmurs?
- short (2-3 days)
- soft (grade I or II)
- systolic
- no other signs/symptoms
What are the top 3 dDx for HTN in a child?
- kidney disease
- renal artery stenosis
- coarctation of aorta
Which one is the MC heart defect in an infant?
tetralogy of fallot
What is involved in tetralogy of fallot
-pulmonary valves stenosis
-overriding aorta
-RV hypertrophy
-VSD
(ASD)
What are Tet spells?
central cyanosis, paroxysmal dyspnea with loss of consciousness
What is rheumatic fever?
complication of strep. pharangitis or skin infxn
What can be implicated with rheumatic fever?
mitral or aortic valves
What is Jone’s Criteria for rheumatic fever diagnosis?
presence of 2 major manifestations or 1 major + 2 minor manifestations
What are the major manifestations of rheumatic fever?
carditis polyarthritis chorea erythema marginatum subcutaneous nodules
What is kawasaki disease?
acute illness (fever) MC affecting young boys under 5
What is the medical management of kawasaki disease?
intravenous gamma globulin and/or aspirin
What is a dDx in a child with spider nevi?
liver disease
What is granulomatous tissue?
serous or serosanguinous dishcarge once the stump has been separated from umbilicus
What is the MC intraabdominal tumor of childhood?
Nephroblastoma (Wilm’s Tumors)
What is a neuroblastoma?
a mass in the adrenal medulla
What would you suspect if you found a sausage-shaped mass in the left or right upper quadrant?
intussusception
When is intussusception MC?
3-12 months old
