Pediatric Exam

Question 1

When is the neonatal period?

Answer 1

1st day to 28th day

Question 2

What age is an infant?

Answer 2

< 1 year old

Question 3

What is the name for the blue cast to hands and feet when exposed to cold in an infant?

Answer 3

Acrocyanosis

Question 4

With acrocyanosis, if blue coloration persists >8hrs or doesn’t disappear with warming or central cyanosis (tongue oral mucosa are blue) what should you suspect?

Answer 4

congenital heart disease

Question 5

When should jaundice resolve by in newborn infants?

Answer 5

about 1 week

Question 6

Which common skin finding has red macules with central pinpoint vesicles scattered over body and disappears in about a week?

Answer 6

Erythema toxicum

Question 7

Pustular melanosis

Answer 7

small vesiculopustules over brown base

*more common in black infants

Question 8

Milia

Answer 8

common skin finding with pinhead-sized smooth white raised area without erythema on nose, chin, forehead: due to retention of sebum in openings of sebaceous glands

Question 9

Fontanelle

Answer 9

Area where major sutures intersect

Question 10

What will a suture feel like on palpation?

Answer 10

ridge

Question 11

When does the anterior fontanelle (4-6 cm at birth) close?

Answer 11

4-26 months

Question 12

When doees the posterior fontanelle close (1-2cm at birth)?

Answer 12

2 months

Question 13

What suggests possibility of neglect between child and caregiver?

Answer 13

lack of eye contact

Question 14

What is defined as tachypnea in a child older than 1?

Answer 14

> 40 breaths per min

Question 15

How is a pulse obtained from a child?

Answer 15

1. Direct auscultation
2. Palpation of heart
3. Brachial/radial pulse (peripheral arteries)

Question 16

In a child, for every 1 degree of fever what happens to HR?

Answer 16

HR is 10-20 beats faster with every degree warmer

Question 17

Is sinus arrhythmia common in children?

Answer 17

Yes, rate is faster with inspiration and slower with expiration

Question 18

In children how do you count respirations?

Answer 18

rise and fall of abdomen

Question 19

How long do you observe respirations in children?

Answer 19

2, 30 sec intervals
or
1 full minute

Question 20

What are some signs of increased respiratory effort in children?

Answer 20

• Retraction (ribs, supraclavicular notch)
• Use of sternocleidomastoid
• Flaring nostrils
• Paradoxical breathing

Question 21

When does routine measurement of blood pressure begin?

Answer 21

3 years old

Question 22

If blood pressure is consistently above the 95th percentile what should be on the differential?

Answer 22

• Kidney disease

- Coarctation of the aorta

Question 23

Where will blood pressure be higher and lower if there is coarctation of the aorta?

Answer 23

High: above point of coarctation

Low: Beyond point of coarctation

Question 24

What is the temperature of the TM in relation to oral temperature?

Answer 24

TM is ~1 degree higher than oral temp

Question 25

What is the technical definition for fever in rectal/ear vs. oral vs. armpit?

Answer 25

rectal, ear (TM) or temporal artery: 100.4 or higher oral: 100 degrees or higher armpit: 99 degrees or higher

Question 26

When measuring height how do you tell that the patient is oriented correctly and looking forward?

Answer 26

outer canthus of eye aligned with external auditory canal

Question 27

When should BMI start to be recorded?

Answer 27

age 2

Question 28

Describe growth pattern for infants

Answer 28

- Growth of trunk predominates | - Fat increases until 9 months

Question 29

Describe childhood growth pattern

Answer 29

- Legs grow fastest | - Prepubertal growth spurt around age 7

Question 30

Describe adolescence growth pattern

Answer 30

- Trunk and legs elongate | - organs and skeletal mass double in size

Question 31

Simian crease, single line across palm of hand is associated which what?

Answer 31

1. Down syndrome | 2. Fetal alcohol syndrome

Question 32

Where will eczema (atopic dermatitis) be on young children versus older children?

Answer 32

``` young children: -face -elbow -knees EXTENSOR SURFACES ``` older children/adults: -hands, neck, elbows, knees FLEXOR SURFACES

Question 33

Impetigo

Answer 33

- highly contagious staph or strep infection of skin - itching, burning "honey colored crusts"

Question 34

Ring worm is a yeast infection of the skin caused by what?

Answer 34

- Tinea capitis (on head) | - Tinea corporis (on body)

Question 35

What are some of the facial characteristics of fetal alcohol syndrome?

Answer 35

- Smooth philtrum - wideset eyes - mild ptosis (lid drooping) - hirsute forehead - short nose - thin upper lip

Question 36

Which lymph node region enlargement is always considered abnormal

Answer 36

supraclavicular

Question 37

When are visual acuity tests with the snellen E chart started?

Answer 37

age 3

Question 38

Which chart is used to assess distance vision?

Answer 38

Snellen

Question 39

What is the name for reduced vision in an eye that appears structurally normal?

Answer 39

ambyopia "lazy eye"

Question 40

By what age would you anticipate a child have 20/20 vision?

Answer 40

6 years old

Question 41

If you elict a white reflex instead of a red eye reflex what should you be concerned for?

Answer 41

retinoblastoma

Question 42

What is the name for a convergent eye pointing inward?

Answer 42

esotropic

Question 43

What is the name for a divergent eye pointing outward?

Answer 43

exotropic

Question 44

What could low or poorly shaped auricles suggest?

Answer 44

- renal disorder | - congenital abnormalities

Question 45

What is the treatment for mastoiditis?

Answer 45

This usually results from untreated otitis media -should treat with IV antibiotics

Question 46

What does a red and inmobile tympanic membrane suggest?

Answer 46

infection in the middle ear

Question 47

Saddle -shaped nose with collapse of the bony portion may be associated with what?

Answer 47

congenital syphilis

Question 48

Strawberry tongue is a feature of what illness?

Answer 48

Scarlet fever (group A strep)

Question 49

What does an adherent white patch in the mouth suggest?

Answer 49

Candidiasis (thrush)

Question 50

Which virus causes Mononucleosis?

Answer 50

Epstein-Barr virus *most common in teens*

Question 51

What symptoms are associated with epiglottitis?

Answer 51

- Sudden high fever - Drooling *** - croupy cough - Respiratory distress. Tripod position 2 neck extended NO TONGUE BLADE!!!!

Question 52

Auscultation of lungs: children

Answer 52

- breath sounds louder, harsher and more bronchial | - Hyperresonance is common

Question 53

Where is the apical impulse observed in a child?

Answer 53

4th and 5th left intercostal space -heart lays more horizontal

Question 54

Venous hum

Answer 54

benign heart finding - caused by turbulent blood in the internal jugular vein - Louder in diastole Best heard: supraclavicular space

Question 55

Still's murmur

Answer 55

-Most common benign murmur -grade 1-2/6, musical, early-mid systolic Best heard: mid or lower left sternal border (2nd pulmonic, tricuspid)

Question 56

If abdomen is hard during both inspiration and expiration (should be soft during inspiration) what should you suspect?

Answer 56

peritoneal irritation

Question 57

What do spider nevi indicate?

Answer 57

liver disease

Question 58

Diastasis recti

Answer 58

midline separation of the rectus abdominus

Question 59

Wilms tumor

Answer 59

Wilms tumor = nephroblastoma (kidney!) * Most common intraabdominal tumor of childhood - Malignant

Question 60

What does a sausage-shaped mass in the left or right upper quadrants indicate?

Answer 60

Intussusception *most common abdominal emergency in children <2 yrs

Question 61

What does a sausage-shaped mass in the left lower quadrant suggest?

Answer 61

feces in sigmoid colon

Question 62

Dance sign

Answer 62

right lower quadrant feels empty - movement of cecum from normal position

Question 63

What is the main reason for sports physicals?

Answer 63

prevent sudden cardiac death

Question 64

Which 4 sports are more commonly associated with sudden cardiac death?

Answer 64

1. football 2. basketball 3. track 4. soccer

Question 65

Most common cause of sudden cardiac death in athletes?

Answer 65

hypertrophic cardiomyopathy

Question 66

When does heart reach adult postion?

Answer 66

age 7

Question 67

Child will have abdominal respirations until age....?

Answer 67

6/7

Question 68

Which temperature is the gold standard for infants?

Answer 68

RECTAL

Question 69

Osgood-Schlatter disease

Answer 69

osteochondritis of tibial tubercle (from repetitive quadriceps contraction leading to subacture fractures or tendon inflammation) (most common: 9-14)