Paediatrics Flashcards Preview

Clinical Medicine > Paediatrics > Flashcards

Flashcards in Paediatrics Deck (67)
Loading flashcards...
1

What are the components of a newborn examination

Cardiac/resp
Red reflex
Fontanelle
Face and mouth
Abdomen
Nappy area
Hips
Limbs
Prone
Reflexes

2

What are the components of a newborn cardiac/resp exam

Listen to 4 areas over the chest, including with the bell- less than 200 bpm is pathologic
- May have innocent murmurs due to flow velocity change in different sized vessels
Anterior resp auscultation is enough in absence of signs
More than 60 breaths is pathologic
Can auscultate abdomen here but low yield
- Inspect and palpate chest after auscultation

3

What are the components of a newborn red reflex exam

- Baby needs to be awake and in a dimmed room, looking through ophthalmoscope with both eyes
- Looking for asymmetry or whitening
- Could indicate congenital cataract/glaucoma or retinoblastoma

4

Describe the anatomy of a fontanelle

Sutures are coronal, saggital, metopic and lambdoid

5

Describe the components of a fontanelle exam

Feel along sutures and both ant and post fontanelles
May initially feel as if they overlap due to pressure from birth
ABNORMAL if no suture or ridge feeling- may be due to pressure from early fusion (craniosynostosis)
Widening within the saggital suture may be due to trisomy 21
If wormian bones are present they will feel like cracked eggshell

6

Describe components of neonatal face and mouth exam

Look for any abnormalities in skull shape and facial symmetry (but check the parents!)
Palate- look at uvula and feel/look at palate for cleft

7

Describe component of neonatal abdominal exam

Inspect and palpate for masses and discoloration
Check umbilical cord for erythema- oomphalitis
Quick feel
Check for liver and spleen, starting in RIF for both
- You can palpate liver and spleen in a normal neonate
Kidneys are low yield

8

Describe the components of the neonatal nappy area exam

Femoral pulses
Fingers into medial hip creases to part labia in girls
Boys- fingers right behind scrotum to check for testes, feeling down
Lift legs up to examine anus

9

Describe the components of the neonatal hip examination

Barlow and ortolani's test

10

Describe barlow's test

Can it dislocate?
Femur adducted, press down and out

11

Describe the ortolani test

Can the hip go back in?
Abduct femur, press in and up

12

Describe the limb exam for the neonate

Count and assess fingers and toes
Check for palmar creases (glyphs)- only one crease in down syndrome

13

Describe the components of the prone neonatal exam

Hold baby prone perpendicular to arm- does baby hold itself rigid for a couple of seconds? Indicates normal tone
Check for sacral dimple/tufts of hair/port wine stain- indicates possible spinal bifida occulta
Skin changes- peau d'orange, masses, rashes

14

Describe the neonatal reflexes to check

Grasp
Root
Suck
Pull to sit- hold baby forearms, lift up- at past 80 degrees head should fall forward
Moro- hold baby's head in palm, drop arm down from 80-20 degrees quickly
- Normal response is symmetric arm abduction and extension, then back to midline
- Abnormal may suggest brachial plexus palsy (Erb's/clumpkies) or clavicle plexus

15

Causes of acute abdominal pain

IBD
Appendicitis
Henoch-Schonlein purpura
UTI
Constipation
Bowel obstruction
Gastroenteritis
Intussusception
Diabetes
Lower lobe pneumonia
Peptic Ulcer
Renal stone
Ovarian torsion/cyst/ectopic
Volvulus

16

Causes of recurrent abdominal pain (categories)

Hepatitis
Gastrointestinal
Urinary
Pancreatitis
Gynaecological
Psychogenic
Abdo migraine
Sickle cell disease

17

Features of IBD on history

Acute abdo pain
Blood or mucus in stools
Weight loss and poor stools
FHx of diarrhoea

18

Features of acute apendicitis

Acute abdo pain
Anorexia
Pain localises to RIF
Peritonism in RIF
Tachycardia
Low grade fever
Vomiting and diarrhoea

19

Features of Henoch-Schonlein purpura

Acute abdo pain
Purpuric rash on legs
Joint pain

20

Features of UTI on history

Abdo pain
Dysuria and frequency
Bedwetting
Back pain
Vomiting
MSU/microscopy is positive

21

Features of constipation on history

Abdo pain
hard or infrequent stools
Mass in LIF
Faecal loading on radiograph

22

Features of intestinal obstruction on history

Abdo pain
Bile stained vomiting
Abdo distension
Consider volvulus

23

Features of gastroenteritis on history

Abdo pain
Vomiting and diarrhoea

24

Features of renal calculi on history

Abdo pain
Hydronephrosis

25

Features of peptic ulcer on history

Abdo pain
Pain at night
Relief with milk
Helicobacter pylori

26

Features of lower lobe pneumonia on history

Abdo pain
Signs of pneumonia
Referred abdominal pain

27

Features of diabetes on history

Abdo pain
Diabetic ketoacidosis

28

Features of intussusception on history

Abdo pain
Intermittent screaming/colic
Shock/pallor
Redcurrant jelly stool is a late sign
3-24mo old
Often following a viral infection
Palpable sausage shaped mass

29

Ix for appendicitis

Bloods- leukocytosis, neutrophilia
Urine to exclude UTI
CT if in doubt

30

Mx for appendicitis

Laparoscopic appendectomy
If perforation- may be adhesions etc.
ABX