Pedia 3B - Applied Pediatric Ward Flashcards by Chris Caangay

Heterophoria

Latent tendency for the eyes to deviate

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Amaurosis

Partial or complete blindness

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Orthophoria

Ideal condition of exact ocular balance

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Heterotropia

Constant misalignment of the eyes

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Dyscoria

Abnormal shape of the pupil

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Scaphocephaly

Head is elongated in the AP diameter

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Turricephaly

Top of the head is pointed

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Plagiocephaly

One side of the head is more rounded

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Oxicephaly

Tower head

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Absence of clavicle

Cleidocranial dyostosis

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Presternal edema

Mumps

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Supernumerary nipples

Renal anomaly

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Pigeon breast

Rickets

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Shield chest

Turner’s Syndrome

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Hyper-resonant on percussion

Emphysema

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Dullness on percussion

Consolidation

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Increase vocal resonance

Consolidation

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Age Related: Infancy

Behavioral problem:

Child neglect

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Age Related: Pre-school

Behavioral problem:

Breath holding

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Age Related: School age

Behavioral problem:

Bed wetting

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Age Related: Adolescence

Behavioral problem:

Acting out behavior

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Lesions - 1’ or 2’

Macule

Primary

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Lesions - 1’ or 2’

Papule

Primary

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Lesions - 1’ or 2’Excoriation

Secondary

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Lesions - 1' or 2' | Crust

Secondary

Lesions - 1' or 2' | Wheal

Primary

Lesions - 1' or 2' | Ulceration

Secondary

Lesions - 1' or 2' | Scar

Secondary

Finding: Exaggerated reflexes | Disease Associated:

Dse of CNS

Finding: Dark Urine | Disease Associated:

Myoglobiuria

Finding: Sensory changes | Disease Associated:

Peripheral Nerve Dse

Finding: ?? | Disease Associated:

Anterior Horn Disease

Type of Rash: Malar Rash | Disease Associated:

SLE

Type of Rash: Erythema marginatum | Disease Associated:

ARD Acute rheumatic disease

Type of Rash: Purpuric Spots over distal portion of extremities Disease Associated:

HSP Henoch Schonlein Purpura

Type of Rash: Evanescent macular rash | Disease Associated:

JRA Juvenile rheumatoid arthritis

Sexual Maturity Rating: | Nipple and areola form a secondary mound

Sexual Maturity Rating: | Scrotal skin is pink/reddened

Sexual Maturity Rating: | Lanugo-like straight lightly pigmented pubic hair

Sexual Maturity Rating: | Larger penis with glans and penile breath increased in size

III

Sexual Maturity Rating: | Abundant dark and curly pubic hair spreading to the medial thighs

Sexual Maturity Rating: | Breast bud stage

Sexual Maturity Rating: | Elevation of papillae only

I??

Lesion: Strawberry nevi Diagnosis:

Capillary hemagiomata

Lesion: Light or dark brown lesion usually seen in sun-exposed parts of the body Diagnosis:

Hyper-pigmentation lesions (FRECKLES)

Finding: Single umbilical cord + Imperforate anus Diagnosis:

Muscle Renal - Ans? Cardio

Finding: Large tongue + umbilical hernia Diagnosis:

Hypothyroidism - Ans ? Down syndrome Hernia

Finding: Incessant crying Diagnosis:

Temp Feeding Bowel movement AOTA??

Finding: Myoclonus knee jerk in 2 week neonate Diagnosis:

Physiologic

Finding: Concave nails (koilonychia) Diagnosis:

IDA | Plummer Vinson Syndrome

Finding: Generalized hypotrichosis Diagnosis:

hypothyroidism??

Finding: Harrison's groove Diagnosis:

Rickets or COPD

Finding: Abdominal pain made WORSE by squeezing is likely due to some ________ condition Diagnosis:

Inflammatory

``` Information: Parity + Gravidity of the Mother Parts of the History: - Prenatal - Natal - Neonatal ```

Prenatal

``` Information: Severity of Jaundice Parts of the History: - Prenatal - Natal - Neonatal ```

Neonatal

``` Information: Spontaneous breathing at birth Parts of the History: - Prenatal - Natal - Neonatal ```

Natal

``` Information: History of Phototherapy Parts of the History: - Prenatal - Natal - Neonatal ```

Neonatal

``` Information: APGAR score of 8 Parts of the History: - Prenatal - Natal - Neonatal ```

Natal

History and PE Finding: Child swallows dirt, crayon, chalk etc Condition:

PICA

History and PE Finding: Generalized jaundice except the sclera Condition:

Lycopenia

History and PE Finding: Excessive thirst and water intake | Condition:

Polydipsia

History and PE Finding: Child regurgitates food into the mouth and chews on it Condition:

Rumination

History and PE Finding: Patient is blue w/o dyspnea | Condition:

Met-hemoglobinemia

Description: Unsteady gait | PE Findings:

Ataxia

Description: Pulse rate INC w/INSP and DEC w/EXP | PE Findings:

Sinus Arrhythmia

Description: Pulse Volume DEC (or disappears) at end of INSP | PE Findings:

Pulsus paradoxus

Description: Rapid, deep respiration in metabolic acidosis | PE Findings:

Kussmaul's breathing

Description: ALT periods of deep and shallow respiration w/recurring periods of apnea PE Findings:

Cheyne stokes? | Compare w/Biot's

To visualize tympanic membrane of older child, the pinna of the ear is held by fingers of one hand and gently pulled:

Up and back | Younger - DOWN

Major Salivary gland(s) located below and in front of the external auditory meatus is/are the:

DON'T KNOW Submaxillary Sublingual Parotid

Complete set of milk (primary) teeth at 24 months:

Accessory muscle of expiration

``` Abdominal INSP - SCM - Scalenii - Trapezii ```

``` DEC vocal fremitus over A Collapsed lung B Pleural Effusion C Lung consolidation D A&B ```

?? I think D

Primary lesion is flat and flushed w/surface of skin blanching w/pressure

Macule

Bronchial breathing is considered abnormal if heard over the

``` Lower aspect of the anterior chest NORMAL - Trachea - Midline of upper anterior chest - Either side of the 2nd thoracic spine, over the posterior chest in small infants ```

Last part of PE (esp in young children)

EARS

The ff information is included in the hx of the PERSONAL habits of the patient EXCEPT - School performance - Sleeping - Toileting - Games and play

Personal habits - Feeding - Sleeping - Toilet - Games/Play - Living condition

The ff are immediate reflection of adequate nutrition of an infant EXCEPT: - sleeps after feeding - Plays - quiet after feeding - Gaines weight

Sleeps after feeding?

Description: Shrieking cry Diagnosis:

CNS disease

Description: Peripheral cyanosis, compared to central, Diagnosis:

Tongue is not blue | Cold extremities

Description: Green colored watery stools Diagnosis:

Rapid intestinal peristalsis

Difference between diastolic pressure of upper and lower limbs

NONE | Systolic difference = 5-10 mmHg higher in lower limbs

Normal resp rate of a NB

?? 30-50 ?? Normal Tachypnea 0-2m 30-50 >60 2-12m 20-30 >50 1-5y 20-30 >40 6-12y 15-20 >30 12-18y 12-18 >24

Palpable or not, NB has __ fontanels

SIX

``` Clinical History: G2P3 Type of History: - Prenatal - Natal - Neonatal ```

Prenatal

``` Clinical History: Mother's age Type of History: - Prenatal - Natal - Neonatal ```

Prenatal

``` Clinical History: Polyhydramnios Type of History: - Prenatal - Natal - Neonatal ```

Natal

``` Clinical History: Phototherapy Type of History: - Prenatal - Natal - Neonatal ```

Neonatal

``` Clinical History: APGAR Type of History: - Prenatal - Natal - Neonatal ```

Natal

Finding: Muscle weakness w/rashes Diagnosis:

Collagen vascular disorders

Finding: Joint tenderness, as a sign of arthritis should be differentiated from Diagnosis:

Proximal bone tenderness Tenderness along tendon attachments Bone pain of leukemia

Finding: Erythema marginatum Diagnosis:

ARF Acute rheumatic fever

Finding: Tenderness of sacro-iliac joint elicited by Diagnosis:

Pretzel test

Finding: Ortolani's maneuver | Tests for:

Hip displacement

Finding: Grower's test Diagnosis: ?

DMD

Finding: Tenderness over tibial tubercle suggests Diagnosis:

Sarcoma

Finding: TRUE migrating pain can be seen in Diagnosis:

Rheumatic fever

Finding: Excessive tearing may be d/t Diagnosis:

Allergy Local irritation of eyes Crying

Finding: Failure of the fontanels to close by 18 months Diagnosis:

Hydrocephalus Ricketts Hypothyroidism

Finding: Unusually long eyelashes Diagnosis:

Malnutrition | Some normal

Finding: Hx of Doctor-shopping Diagnosis:

Possibility of pediatric Munchhausen | What is Sandifier Syndrome

Number of pregnancies reaching the age of viability =

Parity

Number of pregnancies, regardless of viability

Gravida

Snoring is a form of ______ observed during sleep

STRIDOR

Generalized Cyanosis (inc tongue) + warm extremities

CENTRAL

Height should be measured in the ______ position in infants and children less than ___ years old

Supine | <3 years old

Head circumference is measured

1" above the Glabella | Max point of the Occipital protuberance

Axillary temp is usually _____ lower/higher than oral

0.5' lower

Head Circumference > Chest Circumference until ____

6 months of age

Sinus arrhythmia is characterized by RAPID pulse during ______ and SLOWER during

RAPID - INSP | SLOWER - EXP

Narrow cuff gives a ____ reading | Wide cuff gives a ____ reading

Narrow - HIGHER | WIDE - LOWER

Lesions: Crust Type: 1' or 2'

Lesions: Petechiae Type: 1' or 2'

Lesions: Excoriation Type: 1' or 2'

Secondary

Lesions: Atrophy Type: 1' or 2'

Secondary

Lesions: Pustule Type: 1' or 2'

Primary

Prenatal Natal Neonatal Gravity & Parity

Prenatal

Prenatal Natal Neonatal Severity of Jaundice

Neonatal

Prenatal Natal Neonatal Spontaneous breathing at birth

Natal

Prenatal Natal Neonatal History of phototherapy

Neonatl

Prenatal Natal Neonatal APGAR

Neonatal

History and PE | Child swallows dirt, crayon, chalk

PICA

History and PE | Generalized jaundice except the sclera

Lycopenia

History and PE | Excessive thirst and water intake

Polydipsia

History and PE | Child regurgitates food into mouth and chews on it

Rumination

History and PE | Patient is blue w/o dyspnea

Met-hemoglobinemia

History and PE | Generalized cyanosis and warm extremities

Central cyanosis

History and PE Cyanosis (Excluding tongue and w/cold extremities)

Peripheral cyanosis

History and PE | Pacified swallowing

Dysphagia

History and PE | Failure of muscle coordination

Ataxia

History and PE | Unsteady gait

Ataxia

History and PE | Pulse rate INC w/INSP and DEC w/EXP

Sinus arrhythmia

History and PE | Pulse volume DEC (or disappears) at end of INSP

Pulsus paradoxus

History and PE | Rapid, deep respiration in metabolic ACIDOSIS

Kussmaul's breathing

History and PE | Alt period of deep and shallow respiration w/recurring periods of apnea

Biot's breathing

History and PE | Lying still in bed and don't want their abdomen touched

Peritoneal irritation

History and PE | Irritability and dyspnea worsening on lying flat

Congestive heart failure

History and PE | Shrill shrieking and high pitched cry

CNS disease

History and PE | Abdominal pain AGGRAVATED by palpation

Abdominal pain secondary to inflammation

History and PE | Abdominal pain relieved by palpation

Abdominal pain secondary to SPASM

4m w/head circumference larger than chest circumference

NORMAL | H > C 4-6m

History and PE | 12m old w/head circumference larger than chest

Marasmus Hydrocephalus EV Syndrome (small thorax)

History and PE | Noisy musical sound on respiration heard even w/o stethoscope

Wheeze

Prenatal Natal Neonatal Mother's age

Prenatal

Prenatal Natal Neonatal Polyhydromnios

Prenatal

Prenatal Natal Neonatal Meconium staining

Natal

Prenatal Natal Neonatal Duration of nursery stay

Neonatal

Prenatal Natal Neonatal Severity of Jaundice

Neonatal

Prenatal Natal Neonatal Maternal intake of metformin

Prenatal

Prenatal Natal Neonatal NSD

Natal

``` Neonatal Nutritional Natal Past Medical Social and Personal Family Health history of the yaya ```

Family

``` Neonatal Nutritional Natal Past Medical Social and Personal Family Are these the Natural parents? ```

Family

``` Neonatal Nutritional Natal Past Medical Social and Personal Family Usual eating pattern ```

Social and personal

``` Neonatal Nutritional Natal Past Medical Social and Personal Family Is there bed wetting ```

Social and personal

``` Neonatal Nutritional Natal Past Medical Social and Personal Family Was phototherapy done? ```

Neonatal

``` Neonatal Nutritional Natal Past Medical Social and Personal Family 40th week of gestation ```

Neonatal

``` Neonatal Nutritional Natal Past Medical Social and Personal Family Exchange transfusion was done ```

Past medical

``` Neonatal Nutritional Natal Past Medical Social and Personal Family APGAR score ```

Natal

``` Neonatal Nutritional Natal Past Medical Social and Personal Family Two cord coils ```

Natal

``` Neonatal Nutritional Natal Past Medical Social and Personal Family Presence of cataract ```

Neonatal

History and PE | Blood in the sputum

Hemoptysis

History and PE | History of repeated accidents

Past medical

History and PE | Pattern of weight gain

Nutrition

History and PE | Age of weaning

Nutritional

History and PE | Purposeless, repetitive movement

Tics

History and PE | Double vision

Diplopia

History and PE | Involuntary discharge of urine occuring during sleep at night

Enuresis

History and PE | Sensation as if surrounding objects are going round and round

Vertigo

History and PE | Purposeless, non-repetitive involuntary movement

Chorea

History and PE | Slow writhing movements of the distal portion of the extremities

Athetosis

History and PE | Purposeless, non-repetitive movement

Chorea

History and PE | Rapid, oscillatory movements present AT REST

Tremor

History and PE | Slow, rhythmic movements of the extremities and the face

Athetosis

History and PE | Intermittent contractions of a single muscle (or group) resulting in quick, jerky motion of a limb

Myoclonus

Decerebrate or Decorticate | Ext of the neck

Decerebrate

Decerebrate or Decorticate | Flexion of the elbows and wrists

Decorticate

Decerebrate or Decorticate | Extension of the LOWER limbs

Decerebrate and Decorticate

Decerebrate or Decorticate | Pronation of the forearm

Decorticate

Decerebrate or Decorticate | Ext at the elbows

Decorticate

Skin lesions | Blanch w pressure

Macule

Skin lesions | Do NOT blanch w/pressure

Petichiae

Skin lesions | Confluent papules

Plaques

Skin lesions | Larger lesions are called bullae

Vesicles

Skin lesions | Central portion of the lesion paler than periphery

Wheals

Normal or Abnormal | Hydrocele at 3 months

Normal (up to 3 months)

Normal or Abnormal | L scrotum is at a lower level than the right

Norma

Normal or Abnormal | Active bowel sounds in late intestinal obstruction

ABnormal

Normal or Abnormal | Kidney best felt in deep INSP

Normal

Normal or Abnormal | Milky white breasts secretions in a 5d neonate

Normal

Normal or Abnormal | Systolic blood pressure in the lower limbs is higher than upper

NORMAL

Normal or Abnormal | Pulse is rapid during INSP and slower during EXP

Normal

Normal or Abnormal | Head circumference remains larger than chest until 1 year old

Abnormal

Normal or Abnormal | APGAR score of 6

``` Abnormal What's normal? 7 or greater = Good 4-6 - Asphyxiated --> Observe 3 or less --> Resuscitation ```

Normal or Abnormal | Newborn infant w/ weight loss of 20% after birth

ABnormal | 10% is normal

``` Social/Personal Natal Neonatal Nutritional Family Yaya diagnosed with milk PTB ```

Family

``` Social/Personal Natal Neonatal Nutritional Family Sources of support ```

Social/personal

``` Social/Personal Natal Neonatal Nutritional Family Baby sleeps after feeding ```

Nutritional

``` Social/Personal Natal Neonatal Nutritional Family Exchange transfusion ```

Neonatal

``` Social/Personal Natal Neonatal Nutritional Family Oliohydromnios ```

Natal

``` Prenatal Natal Neonatal None Term of pregnancy ```

Prenatal

``` Prenatal Natal Neonatal None Phototherapy? ```

Neonatal

``` Prenatal Natal Neonatal None Polyhydramnios ```

Natal

``` Prenatal Natal Neonatal None Meconium staining ```

Natal

``` Prenatal Natal Neonatal None Adequacy of milk intake ```

None | Nutritional?

``` Prenatal Natal Neonatal None Teenage pregnancy ```

Prenatal

``` Prenatal Natal Neonatal None G1P1 ```

Prenatal

``` Prenatal Natal Neonatal None Birth weight ```

Natal

``` Prenatal Natal Neonatal None Forceps delivery ```

Natal

``` Prenatal Natal Neonatal None Induced labor ```

Natal

Physiologic or Pathologic | Cephal-hematoma

Physiologic

Physiologic or Pathologic | Ebstein pearls

Physiologic

Physiologic or Pathologic | Erythema toxicum

Physiologic Def: common rash in neonates. Appears in up to half of newborns carried to term usually 2-5 days after birth; it does not occur outside neonatal period. Blotchy red spots on skin w/overlying white or yellow papules or pustules.

Physiologic or Pathologic | Positive ankle clonus at 1 week

Physiologic

Physiologic or Pathologic | Unequal Moro reflex

Pathologic

Physiologic or Pathologic | Caput succedanum

Abnormal Def: Neonatal condition involving sero-sanguinous, subcutaneous and extra-periosteal fluid collection w poorly defined margins cause by pressure of the presenting part of the scalp against the dilating cervix during delivery

Physiologic or Pathologic | Scaphoid abdomen at birth

Physiologic

Physiologic or Pathologic | Bounding dorsalis pedis pulses

Physiologic

Physiologic or Pathologic | Millia over the tip of the nose at 3 days of life

Pathologic Milia are small raised pearly white or yellowish bumps on the skin usually around cheeks nose eyes, forehead and chest Common in newborns Tiny skin cyst filled w/keratin

Physiologic or Pathologic | Peripheral cyanosis at 4 hours of life

Pathologic

Physiologic or Pathologic | 36.7' C at 24h of life

Abnormal

Physiologic or Pathologic | Head circumference of 34cm

Abnormal

Physiologic or Pathologic | Globular abdomen at 48h of life

Abnormal

Physiologic or Pathologic | RR of 60/min at 1h of life

Abnormal

Physiologic or Pathologic | (-) Fencing reflex at 1w

Normal

Physiologic or Pathologic | Consumes 15cc of breastmilk at 12h of life

Abnormal

Physiologic or Pathologic | (+) GRasp reflex at 24h of life

ABnormal

Physiologic or Pathologic | Passage of urine at 30h of life in 34 week neonate

Abnormal

Physiologic or Pathologic | (+) Crepitations over the clavicular area

Normal

Physiologic or Pathologic | (+) Head lag at 2w of life

Abnormal

Physiologic or Pathologic | Hydrocoele at 3m

Normal

Physiologic or Pathologic | Umbilical cord stump falls off at 21 days

Abnormal? Falls off 6-18d Heals 12-21d

Physiologic or Pathologic | Urethral discharge in a 3d male

Normal

Physiologic or Pathologic | Highly pigmented genitalia in a female newborn

Normal

True/False | In taking the hx, remember to have a period of communication with the child even though the parents are speaking

True

True/False | Important to use both open-ended and leading question

True

True/False | During the process of questioning, if a parent does not look in your eyes directly it always means evasion

False

True/False Following history of doctor-shopping by the family, one must be aware of the possibility of pediatric version of "Sandifier Syndrome"

False Munchausen Sandifer syndrome - spasmodic torsional dystonia + arching of the back + rigid opisthotonic posturing, mainly involving the neck, back, and upper extremities, - associated with symptomatic gastroesophageal reflux, esophagitis, or the presence of hiatal hernia

True/False | Gravida is defined as the unmber of pregnancies reaching the age of viability

False | Parity

True/False | Snoring is a form of grunt which occurs during sleep

False | Stridor

True/False | Height should be measured in the supire position in infants and children below 2yo

False | 3yo

True/False | Head circumference is measured at the maximum point of the glabella and a point 1 inch above the occipital protuberance

False | 1" above the glabella and the most prominent aspect of the occipital protuberance

True/False | Normally at birth, HC > CC ad remains so until 6m

True

True/False | Axillary temperature is lower than oral

True | Axillary temp is at least 0.5'C lower than oral

True/False | Sinus arrhythmia is characterized by rapid pulse during expiration and slower during inspiration

False Rapid - INSP Slower - EXP

True/False | A narrow blood pressure cuff will give spuriously high blood pressure reading and broader cuff will give a lower reading

True

True/False | Movement is lost in both pyramidal and and extra-pyramidal dse

True

True/False | Presence of Moro is normal up to 6m

False

True/False | Absence of balancing reflex for sitting after 8months is abnormal

True

True/False | Knee jerk is an example of a deep reflex

True

True/False | Social smile is observed at 3 months

False

True/False | Bloody vaginal discharge among newborns is pathologic

False Males should NOT have any discharge Meningeal signs:

True/False | Pleural pain gets worse on coughing. Also true for INC ICP

True

True/False | In carotenemia and lycopenemia, the sclera is not icteric

True

True/False | In PICA, aside from mental retardation, there is a history of swallowing anything inedible

False Mental retardation must be ruled out to consider PICA

Pedia 3B - Applied Pediatric Ward Flashcards

(254 cards)