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Pediatrics Physical Exam and Lab Values > Physical Exam > Flashcards

Physical Exam Flashcards

1
Q

First thing you check with a child when you go into the room?

A

Say hello, smile, and introduce yourself.

See the general condition of the child (Are they healthy? Well fed? Good condition?)

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2
Q

Official temperature of a baby? Where do you check?

A

L

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3
Q

First you check the skin. What is a common skin lesion on infants? What two things do you check, where?

A 
Look for skin lesions (especially hemangiomas)
Prick test (infants belly button and forearm for toddler)
Capillary refill test (less than 2 seconds on toddle and infants if it is done sternum because they have slower peripheral circulation)
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4
Q

Head and neck exam

A
  1. ) Check eye movements
  2. ) Sclera (color, can be blue in osteogenesis imperfecta and red, conjunctivitis)
    - High carotene (pumpkin and carrots can’t cause eye color change but skin oranging)
  3. ) We check lymph nodes (plus auxiliary [check bcg left lymph nodes] and femoral nodes and vessels), conjunctiva, and mouth
  4. ) Check the fontanelles for size and if it is even, protruding, and sunken in
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5
Q

Pulmonary system exam includes and what is seen on inspection

A

Inspection, percussion, palpation
-chest inspection (pectus excavatum, pigeon chest, scoliosis, asthma (under 4)=obstructive bronchitis until proven as asthma but some babies also just have barrel chest [barrel chest]
Breathing rate and cough/wheeze

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6
Q

Pediatric pulmonology inspection

A

Inspection

  • Cyanosis (lips and peripheral limbs)
  • irritability
  • nasal flaring
  • coughing or choking
  • tripod position (use of accessory muscles to aid in breathing)
  • grunting (kid tries to increase PEEP)
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7
Q

Percussion pulmonology treatment

A

Percussion (some institutes say it’s not valuable in pediatrics)
Done in cases where fluid is present

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8
Q

Pulmonology Auscultation steps

A
  • compare the both sides like with adults (apex)
  • start from below in kids and work your way up. Kids have pneumonia or bronchitis and are heard best at beginning before airways open with air in the examination
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9
Q

Two types of breath sounds

A

Bronchial and vesicular breathing

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10
Q

Which breath sound is the loudest

A

Bronchial breathing is heard over most of the back due the kids being so small

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11
Q

Do you hear bronchial and vesicular breathing on inspiration or expiration

A

Bronchial breathing is heard both on inspiration and expiration. Vesicular breathing is heard only on inspiration

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12
Q

What happens when bronchial breathing is increased?

A

Vesicular sounds decreased indicating pneumonia, with exudate inside alveoli or transudate edema due to right heart failure or tumor

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13
Q

What makes breathing sounds fainter in general?

A

Pneumonia, pneumothorax, tumor, pleural effusion, less chest movement (Pleuritis, phrenic nerve issue, dermatomyosisitis, duchenne, polymyotitis, emphysema)

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14
Q

Adventitious lung sounds

A
  • Friction sound
  • Crackle sound
  • Rales
  • Stridor
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15
Q

Friction sounds can be found in

A

Pleuritis and can be differentiated from pericardial issues by the patient holding their breath

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16
Q

Crackle sounds are due to? When is it heard? Causes?

A

Crackles sounds are caused by semi filled alveoli and when the patient inhales the alveoli collects some air and pops open. Only heard in inspiration. Caused by fluid from infection or arrhythmia.

17
Q

Rales can be separated into 2 types

A

Wet type and dry type

18
Q

What is wet type rales

A

wet type is when fluid or mucus in bronchioles and alveoli, heard in inspiration and expiration (moist bubbling sound)

19
Q

What is dry type rales

A

Dry type is whistling due to dry mucus in the bronchi and lead to wheezing sounds best heard in expiration (asthma and obstructive bronchitis)

20
Q

What is stridor and when can it be heard

A

Dry type is whistling due to dry mucus in the bronchi and lead to wheezing sounds best heard in expiration (asthma and obstructive bronchitis)

21
Q

What can be heard in pneumonia? Obstructive bronchitis?

A
  1. ) diminished sounds, crackle, rales

2. ) Wheezing/rales

22
Q

Abdomen exam order

A
  • inspect abdomin (stomach is higher than chest is normal
  • auscultate abdomen for 1 minute if they don’t have bowel sounds
  • general palpation
  • palpate and percuss spleen (in bigger kids)
  • percussion of liver after asking patient to turn on side (liver dullness)
23
Q

When to palpate bladder

A

During urinary retention you palpate bladder.

Causes include obstruction bph, neurologic damage, drugs, psychologic

24
Q

Kidney palpation

A

Feel for costobertebral triangle, try to catch it after they breath in

25
Q

Palpate deep to try to feel which two tumors developing

A

Wilma and neuroblastoma (retroperitoneal tumors)

26
Q

Different lymph nodes and causes for reactiveness

A

Occipital lymph nodes-rubella, bartonella
Posterior auricular-
Preauricular-
Submandibular- tonsillitis (strep), mononucleosis (check spleen and liver, maculopapular rash due to amoxicillin on day 7)
Submental-
Posterior cervical-chronic otitis (not pathological if you feel many lymph nodes)
Superior cervical-
Supraclavicular- always pathological if palpated
Infraclavicular- always pathological if palpated
Jugular- always pathological if palpated (all three drain from mediastinum and gastric tumors)
Auxiliary (arm at 90 degree angle)- cat scratch, RA, any scratches in the limb
Femoral-
Inguinal-since whole leg drains to that area, kids fall all the time and get cuts. So it is normal to have reactive lymph nodes

27
Q

What to check on head beside the lymph nodes

A

Check the mouth, normal color, normal sized tonsils

28
Q

Pathological/malignant lymph nodes are described as

A

Not mobile, hard, larger than 1 cm (first test to do is US to see if reactive or pathological)

29
Q

Meningeal tests include?

A

Brudzinski’s and Kernig test

30
Q

For meningeal signs check what first?

A

Check neck stiffness (up, down, side to side)

31
Q

Bruzinski sign

A

One hand behind the head and one on sternum will cause the knees to jerk if it is positive
(back can be painful if there is menigeal inflammation)

32
Q

Kernig sign

A

Lift leg up to 40-60 degrees straight, a positive sign is that it’ll bend at the knee

Or
Lift knee in bent position 90 degrees
And try to straighten leg

33
Q

What symptoms do you try to look for for systemic signs of meningitis

A 
With children you look for system signs
Fever
Bulging fontanelle
Bent back (optistotimus) meningitis and tetanus
Crying or lethargy (high pitched)
Extended limbs, don’t respond to pain stimuli
Hypertension plus bradycardia
Sunset eyes
34
Q

Causes of Meningeal sign

A

Meningeal sign
Encephalitis, meningitis, muscle rigidity (torticolis, or cervical spine inflammation like ankylosing spondylitis)
And dehydration (edema of brain)
Hydrochephalus, hemorrhage (AV malformation), tumor

35
Q

How to differentiate between dehydration and meningitis?

A

To differentiate between dehydration and meningitis give iv bolus, wait an hour, see if nuchal rigidity improves
If not treat with ceftriaxone

36
Q

Signs of dyspnea

A

Signs of dyspnea

  • nasal flaring
  • intercostal retraction (see the ribs)
  • subcostal retraction
  • jugular retraction
  • paradoxical breathing
  • difficulty with expiration (prolonged)
37
Q

Shape of chest in pulmonary disease

A

Shape of chest

  • shape of chest of newborn-barrel shaped chest
  • as they grow their chest becomes flatter (2/3 back to front to the length in front of chest)
  • if barrel chest continues there is chronic bronchitis
38
Q

Causes of Tachypnea

A

Tachypnea

  • infection (sepsis)
  • anemia
  • circulatory problem
  • respiratory distress

Pediatrics Physical Exam and Lab Values (9 decks)

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