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Physical Exam 2 Didactic Midterm > Pediatrics > Flashcards

Pediatrics Flashcards

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1
Q

Heart sound that is normal in children?

etiology

best heard

sounds like

A

S3

etiology- Due to rapid ventricular filling

best heard - LLSB, or apex

_sounds lik_e - low pitched early diastolic

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2
Q

pediatric murmur characterized by vibratory, musical buzzing?

heard best?

timing?

A

Stills

Small aortic root/ascending aortic diameter -> high velocity flow across LVOT-ascending aorta

heard best-

  • 3rd intercostal space
  • LLSB
  • apex
  • louder in suprine position

timing- systolic ejection

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3
Q

name benign and malignant pediatric murmurs

A

benign -

S3

Peripheral pulmonary flow murmur (PPS):

Still’s murmur:

Venous hum:

Malignant: VSD

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4
Q

•Soft, hollow, continuous murmur, louder in diastole

heard best?

A

Venous hum:

below R clavicle

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5
Q

pathologic murmur first noticed in newborn

heard best?

diastolic / systolic?

A

LLSB

Short systolic or holosystolic

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6
Q

where are these pediatric murmurs heard best?

S3

Peripheral pulmonary flow murmur (PPS):

Still’s murmur:

Venous hum:

Ventricular septal defect (VSD)

A

S3 -

LLSB,

apex

Peripheral pulmonary flow murmur (PPS):

RUSB or LUSB

Radiates to back & axilla

Still’s murmur:

3rd intercostal space

LLSB

apex

Louder in supine position

Venous hum -

below R clavicle

eliminated lying supine

Ventricular septal defect (VSD) - LLSB

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7
Q

pediatric murmur heard best at

RUSB or LUSB & Radiates to back & axilla

A

Peripheral pulmonary flow murmur (PPS):

Common benign functional murmur

•newborns & infants, Usually disappears by 1 y

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8
Q

venus hum Can be eliminated by

A
  • lying supine
  • changing head position
  • JV compression
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9
Q

Peripheral pulmonary flow murmur (PPS): is caused by

A

turbulence from size discordance of larger main PA-smaller branch PA

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10
Q

stills murmur is caused by

A

Small aortic root/ascending aortic diameter -> high velocity flow across LVOT-ascending aorta

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11
Q

murmur that is Louder in supine position

A

Still’s murmur:

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12
Q

what are the murmurs?

Low-pitched, early diastolic sound

•Mid systolic ejection murmur

Short systolic or holosystolic

Vibratory/musical/buzzing SEM

Soft, hollow, continuous murmur, louder in diastole

A

Low-pitched, early diastolic sound - S3

•Mid systolic ejection murmur - PPS

Short systolic or holosystolic - VSD

Vibratory/musical/buzzing SEM - Stills

Soft, hollow, continuous murmur, louder in diastole - venous hum

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13
Q

what is the best location to hear these murmurs?
venous hum

stills

A
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14
Q

what murmur is the only one that radiates?

where does it radiate?

A

PPS

back & axilla

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15
Q

what are the 2 hip examination maneuvers?

what age are they preformed

A

performed up until 3m of age)

Barlows

Ortolanis

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16
Q

describe Barlow’s test and positive findings

A
  1. flex and ADDUCT the hips by bringing thigh near midline
  2. apply light pressure on knee and direct force posteriorly

positive findings:

femoral head dislocated posteriorly fro acetabulum

dislocation is palpable as head slips out of acetabulum

confirm w/ Ortolani’s test

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17
Q

describe Ortolanis test

A
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18
Q
  • Hip evaluation important to r/o ____?
  • All infants should have serial hip examinations until _____??
A

Developmental Dysplasia of Hip (DDH)

until they are walking

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19
Q

Risk factors for Developmental Dysplasia of Hip (DDH)

A
  • F
  • In utero breech position
  • +FHx
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20
Q

hip special tests according to age

newborns

infants

older

A

newborns (performed up until 3m of age)

•Barlow

Ortolani maneuvers

infants

  • Evaluation of hip abduction -> limited abduction: concerning
  • Evaluation of symmetry of gluteal folds -> asymmetry: concerning
  • Galleazzi test - used to assess for hip dislocation, specifically testing for developmental dysplasia of the hip.

older - Trendelenburg sign (weak hip abductors)

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21
Q

describe galleazi test and what it is udef for

A

infant hip exam: assess for hip dislocation, specifically testing for developmental dysplasia of the hip.

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22
Q

scoliosis assessment

Study These Flashcards
A

Evaluation of shoulder-scapula-hips symmetry w/ pt standing

_Adams forward bend tes_t -> Scoliosis:

•Asymmetrical rise in the thoracic region or lumbar region, or both

scoliometer to test scoliosis degree

•If angle > 7° -> Abnormal -> Ortho- referral

23
Q

abnormal scoliometer finding?

Study These Flashcards
A

angle > 7°

Ortho- referral

24
Q

Tanner staging of pubic hair development in boys

Study These Flashcards
A

Stage I – Prepubertal, no pubic hair

Stage II- sparse, straight pubic hair along base of penis

Stage III – hair is darker, coarser and curlier extending over mid-pubis

Stage IV – hair is adult-like in appearance but does not extend to thighs

Stage V – hair is adult-like in appearance, extending from thigh to thigh

25
Tanner staging of pubic hair development in girls
•**Stage I** – no pubic hair **•Stage II** – sparse straight hair along lateral vulva **•Stage III** – hair is darker, coarser and curlier extending over the mid-pubis **•Stage IV** – hair is adult-like in appearance, does not extend to thighs **•Stage V** – hair is adult-like and extending from thigh to thigh
26
Tanner Stages of External Genitalia Development males
**Stage I** – Prepubertal **Stage II**- enlargement of testes and scrotum, scrotal skin redness and changes in texture **Stage III** – enlargement of penis (length first), further growth of testes **Stage IV** – Increased size of penis w/ growth in breadth * development of glans * testes and scrotum larger and scrotal skin darker **Stage V** – adult genitalia
27
what are 2 possible dx seen in pediatric males w/ complaint of scrotal edema
hydrocele hernia
28
hydrocele vs hernia testicular involvment reducible transilumination (+/-) tx
**hydrocele** _testicular involvmen_t - YES, Overlies testes & spermatic cord _reducible_ - NO _transilumination_- + _tx_ - spontanous resolution in 18 mo **hernia** _testicular involvment_ - NO, independent from testes _reducible_ - YES _transilumination_ - NO _tx_ - no spontaneoud resolution, surgical repair
29
what is very important to NOT do in cases of Hypospadias
•NO CIRCUMCISION – if need to be repaired they will need the extra skin
30
# define & their causes, cross suture lines? Caput succedaneum Cephalohematoma
**Caput succedaneum** _Define_: Edematous scalp swelling about the periosteum _cause_: prolonged engagement of head in birth canal or if vacuum extraction _cross suture line:_ YES **Cephalohematoma** _Define_: Subperiosteal blood collection _cause_: More common in vacuum or forceps assisted deliveries -\> (appears within first 24 hours) c_ross suture line:_ NO
31
Tx ## Footnote Caput succedaneum Cephalohematoma
**Caput succedaneum** - Benign - Resolves in 1 - 2 days **Cephalohematoma** - Usually resolves within several weeks Overall benign, though may develop complications: * Calcification * ↑risk of neonatal jaundice * Infection
32
Cephalohematoma complications
* Calcification * ↑risk of neonatal jaundice * Infection
33
on inftant head exam define: Tx? ## Footnote Positional plagiocephaly Craniosynostosis
**Positional plagiocephaly** - •Flattening of parieto-occipital region _Tx:_ Resolves w/ time & as infant becomes more active (Increase in “tummy time” helps) **Craniosynostosis:** Premature fusion of cranial sutures * Skull growth restricted perpendicular to affected suture * Compensatory skull growth parallel to affected suture _Tx:_ surgical reconstruction
34
normal & abnormal findings assoc w/ red reflex
**Normal:** * Red/orange color reflected from fundus through pupil * Should be symmetric without opacities or spots **If abnormal-\> Ophtho- referral** * _Cornea cloudiness_ = congenital glaucoma * _Dark light reflex_ = cataract, retinopathy of prematurity * _White retinal reflex (leukokoria)_ = cataract, retinal detachment, chorioretinitis, or retinoblastoma
35
Tanner Staging of Brest Development F
**•Stage I** – prepubertal w/ no palpable breast tissue **•Stage II** – development of _breast bud_, w/ elevation of papilla and _enlargement of areolar diameter_ **•Stage III** – _enlargement of the breast_, without separation of areolar contour from breast **•Stage IV** – _secondary mound_ the areolar and papilla project above the breast **•Stage V** – _resection of areola_ to match the contour of the breast, the papilla projects beyond the contour of the areola and breast
36
Children can have normal sinus dysrhythmia: \_\_\_ HR during inspiration \_\_\_\_\_ HR on expiration
INC HR during inspiration DEC HR on expiration
37
Absent or diminished femoral pulses can indicate??
coarctation of aorta
38
On first few days of life newborns can have transient murmurs causd by?
•closure of PDA
39
Speculum exam CONTRAINDICATED in pre-pubertal child unless...?
suspicion for trauma or foreign body
40
differentiate: ## Footnote Diaper Dermatitis Candida Diaper Rash
Diaper Dermatitis - spares skin folds Candida Diaper Rash - Involves skin folds & Satellite lesions
41
All infants should have serial hip examinations until they are \_\_\_?
walking
42
what should always be checked as part of infasnt neuro exam?? abnormal if??
Primitive reflexes: part of newborn & infant exam * Abnormal if: * Absent during neonatal period * Asymmetric * Persistence beyond age by which should have normally disappeared
43
name the primative reflex age of appearance age of resolution
Moro age of appearance - 34-36wks age of resolution - 5-6 mo Palmar age of appearance - 38-40 wks age of resolution - 5-6 mo Plantar age of appearance - 38-40 wks age of resolution - 9-10 mo Rooting age of appearance - 38-40 wks age of resolution - 9-10 mo
44
what primative reflex should appear by ## Footnote 34-36wks 38-40 wks
34-36wks - Moro 38-40 wks - Palmar Plantar Rooting
45
what primative reflex should disappear by ## Footnote 5-6 mo 9-10 mo 2-3 mo
5-6 mo - Moro &Palmar 9-10 mo - plantar 2-3 mo - rooting
46
when is Head Control Assessment normal vs abnormal
By 40 wks infant has sufficient neck and truncal strength to maintain some head control •head in line w/ trunk for one- or two-seconds while being pulled from supine to sitting abnormal •Hypotonia – head lags behind as infant is pulled from supine to sitting and continues to lag when sitting position is reached
47
nose exam in newborns focuses on ??
•Evaluation of patency of nares in Newborns:
48
Choanal atresia
* Blockage or obliteration of posterior nasal aperture * Usually associated w/ bony abnormalities of pterygoid plates of sphenoid & midfacial growth abnormalities * If BL atresia - causes respiratory distress immediately after birth * Requires surgical repair
49
Newborn OP exam should always evaluate for? describe technique
Evaluate for cleft lip &/or palate: ## Footnote * Always visualize till uvula & pharynx * Always palpate palate to check for submucosal cleft * Bifid uvula may be a normal finding or associated w/ submucosal cleft
50
what is different abour newborn neck exam? what does neck exam include?
Neck is Non-existent! _Clavicle palpation:_ Fx of clavicles may occur during birth Decreased ROM of affected side Tenderness, crepitus, bone swelling, asymmetric Moro
51
rectal newborn exam includes??
•Inspect location & patency of anus DRE is NOT routinely performed
52
+ Barlow's and Ortolanis tests
+ Barlow - posterior femoral head dislocation + Ortolanis - femoral head reduced into acetabulum
53
describe how to perform barlows ortolanis
**_barlows_** - flex and _ADDUCT_ the hip while applying light posterior force to knee **_ortolanis_** - flex and _ABDUCT_ the thigh

Physical Exam 2 Didactic Midterm (4 decks)

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