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Mid term exam study guide
Terms in this set (106)
When assessing an infant or toddler save this exam for last?
The eyes ears nose and throat exam is generally very stressful for the infants and toddlers and elicits resistance and crying so when you do your exam save this part for last
When does the posterior fontanelle close on a baby
The posterior fontanelle may close at birth and should always be closed by 2 to 3 months of age.
When does the anterior fontanelle close on a baby
The anterior fontanelle closes by 9 to 18 months
What sinuses are present at birth
The ethmoid sphenoid and maxillary sinus is our present at birth but they are tiny
When do the frontal sinuses develop
The frontal sinuses develop between four and seven years of age
And abnormally large head circumference can indicate what
An abnormally large head circumference can indicate hydrocephalus, brain tumor, cerebralgigantism, neurofibromatosis, hemorrhage and autism
A small head circumference can indicate what?
A small head circumference can indicate craniostenosis, microcephaly, a mother who used cocaine or alcohol, or who experienced intra-uterine infection
Premature closure of the suture lines requires further evaluation
Cephalhematoma is a collection of blood in the sub periosteal area of the scalp that does not cross the suture line
Minor asymmetry of the head is normal in infants up to what age
Minor asymmetry of the head is normal in infants up to four months old
A flattened occiput may indicate what?
Persistent placement in the supine position
A gaping skull wound can indicate what?
A gaping skull wound can indicate a compound skull fracture
To visualize the tympanic membrane of an infant or child less than three years old how do you hold the ear
Pull the earlobe down and back
The edges of the optic disc should look like what?
The edges of the optic disc should be crisp round and even
To test and assess the extra ocular muscles movement you will use what tests?
You will use cover and uncover corneal, light reflex, & spinning and twisting
What does the red reflex test assess for
The red reflex test assesses the retina & cornea
When evaluating the eyes what is the consensual reaction?
The consensual reaction happens when you point a light at the patient's pupil which contracts and then the other pupil that was not exposed to the light also contracts also
When do you use the large aperture?
The large aperture should be used for all funduscopic exam's in a dark room
What kind of an anomaly is associated with preauricular skin tags
Renal anomalies are associated with pre-ocular skin tags in addition to it being a normal inherited family trait.
Appearance of Scalera between the upper lid and the iris may indicate hydrocephalus
The ptosis is a dripping or falling at the upper eyelid. The dripping maybe worse after being awake a long time.
What can ptosis be an indication of
The ptosis can be an indication of paralysis of oculomotor nerve or myasthenia
What is lid lag?
Lead lag is incomplete closure of the eyelid and can indicate hyperthyroidism
What is the key family history component for a child with heart disease.
Family h/o genetic syndrome in a sibling
Family h/o CHD/chromosomal anomalies, suddenly/premature death. (D p. 85)
Three Major Fetal Structures that close soon after birth
Ductus Arteriosis(24-48 Hours)
Ductus Venosus (Umbilical vein to IVC) (with first breath)
Foramen Ovalle PFO (first few years of life)
Correct way to assess for thrills
Feel the chest with the base of the fingers
At 12 months an innocent murmur at the left stern all border is
A normal finding and should be reevaluated at 15 month checkup.
Appropriate auscultation sites are
2nd intercostal space at right sternal border
3rd intercostal space at left sternal border
5th intercostal space left of sternal border
During auscultation where is S2 heard best?
2nd intercostal space at the left and right sternal boards (The base of the heart)
Best way to assess femoral pulses of a 6 month old
Simultaneously using the first and second digits of each hand.
A murmur that is barely audible and softer than usual heart sounds
Grade 1 murmur
A murmur that is still soft, but about at loud as usual heart sounds
Grade 2 murmur
A murmur that is louder than usual heart sounds but without a thrill
Grade 3 murmur
A murmur that is louder than usual heart sounds and with a thrill
Grade 4 murmur
A murmur that can be heard with the stethoscope barely on the chest (rare)
Grade 5 murmur
A murmur that can be heard with the stethoscope off chest, or with naked ear (extremely rare)
Grade 6 murmur
Pt with diminished femoral pulses and a blood pressure difference between the right arm and lower extremities, most likely has what?
Coarctation of the aorta.
A grade II Venous hum murmur during a 4 year old's physical examination is what?
An innocent murmur
Common in 3 to 6 years old.
Which pathogen is the most likely cause of rheumatic fever
Group A Streptococcus
Earliest age at which a satisfactory radial pulse can be taken in children
2 years old.
Both systolic and diastolic BP are < 90th percentile is classified as
Systolic and/or diastolic BP >/= 90th percentile or BP exceeds 120/80 mmHg
Systolic and/or diastolic BP falls between the 95th percentile and 55 mmHg above the 99th percentile
Stage 1 hypertension
Systolic and/or diastolic BP Measures >/= 95th percentile measured on three separate occasions.
Systolic and/or diastolic BP >/= 99th percentile + 5 mmHg.
Stage 2 Hypertension
What is a finding consistent with long standing cyanosis
Clubbing of the nails
What signifies the beginning of systole?
Soft murmur about as loud as the usual heart sounds, is grade what?
Grade 2 heart murmur.
Common fetal structures that close within the first few days to months of life are
Patent Foramen Ovale
Patent Ductus arteiosus
Most up to date standardized growth charts can be obtained where?
Scotty nodes are frequently seen in children and they are described how?
Less than 1 cm, nontender and easily movable.
For a pt with a fixed, nontender, hard, 1.5 cm anterior cervical lymph node in a 12 year old, what is the MOST important action to take?
Refer the child to pediatric oncologist immediately.
Child with tender, mobile, soft less than 1 cm anterior cervical lymph nodes would be suspected of what?
Strep pharyngitis & Mononucleosis also however the nodes may approach 1.0 cm or more.
Skin lesion that is a localized skin color change, < 1 cm in diameter and nonpalpable is what?
A skin lesion that is non palpable, localized skin color change that is > 1 cm
A palpable skin lesion with local edema in the epidermis that causes irregular elevation, may be red or pale.
A PALPABLE skin lesion of localized skin color that is less than 1 cm
If there is something in a child's hair that looks like dandruff but doesn't flake off easily suspect what?
Transient mottling, lattice-like pattern noted on the extremities and trunk when the infant is exposed to cooler temperatures. Due to vasomotor changes in the dermis and subcutaneous tissue
Transient cyanosis of one-half of the body is due to vascular instability. The lower half of the body becomes pink and the upper half is pale.
Harlequin color change
Capillary hemangioma, that are flat and of deep pink color that blanches easily. They are usually found on the eyelids, nose, and nape of the neck
Vascular Nevi aka stork bites
Irregular areas of deep blue pigmentation with the appearance of ecchymosis.
Caused by infiltration of melanocytes into the dermis.
Usually found in the sacral and gluteal regions
Seen predominantly in children of AA, Asian, and Hispanic descent.
Last for several years and eventually fade.
MAY be confused with bruising and/or signs of a child abuse.
If a newborns eyes are low set, approx. 1 cm below the position of the eyes what do you do?
Close inspection or other body parts
Vesicles with erythematous bases around the mouth and under the nose, some vesicles ruptured with thick, honey colored crusts. What common skin condition is described.
A superficial infection of the skin characterized by pruritis, localized swelling, and the formation of tiny dome-shaped pustules and red papules at follicular openings. Often observed in the auxiliary and/or genital area secondary to shaving.
A poxvirus that presents as pearly colored, dome-shaped papules with central umbilication. Frequently present in groups on the face, upper body, and axillae, although may appear anywhere on the body.
Skin d/o that presents with localized area of erythema and/or pruritis. Lesions may be characterized by erythema, scaling, or vesicles.
Soft, low pitched sound
Heard over entire surface of lungs
Inspiration > expiration
Moderately loud and pitched sounds
Heard over inter scapular area
Heard on inspiration and expiration
Inspiration = expiration
Bronchial (tubular) breathsounds
Loud and high pitched sounds
Heard over trachea near supra sternal notch
Louder on expiration
Inspiration < Expiration
Loudest and highest pitched sounds
Heard over the trachea
Heard on inspiration and expiration
Inspiration = expiration
Seesaw breathing is often seen in newborns and infants because they use abdominal muscles more than intercostal muscles.
Characterized by cycles of increasing and decreasing tidal volumes separated by apnea. Occurs in children with congestive heart failure and increased ICP.
Normal in infants up to 2 y/o
Also seen when chronic air trapping is present such as in advanced stages of cystic fibrosis.
Deformities of the chest that can impact the child's respiratory status and decrease expansion of the lungs
Pectus excavatum and
Heard primarily on expiration
Associated with: Foreign body aspiration, bronchiolitis, asthma
Crackles are described how
Crackles are Discontinuous
Heard primarily on inspiration
Do not clear with cough
Associated with pneumonia, pulmonary edema, cystic fibrosis
Fine crackles are described how
Soft and higher pitch
Generally indicative of fluid in smaller airways in infants and children
Do not clear with cough
Coarse crackles are described how
Loud and lower Pitch,
Usually signify fluid in large airways
Clear with cough
Rhonchi Is described how
Clears with cough
Caused by secretions/mucous in larger airways as in bronchitis and lower respiratory tract infections.
Strider is described how?
Heard primarily with inspiration
Associated with laryngotracheobronchitis, laryngomalacia, subglottic stenosis, and vocal cord dysfunction
If apnea is prolonged and > 20 seconds and accompanied by central cyanosis what is needed
This is abnormal and requires immediate further evaluation
Cyanosis of the Hands and feet, is normal for newborns and can persist for days if the infant is in a cool environment.
Occurs in the conjunctiva, lips, mucous membranes, and nail beds. Is an abnormal finding at any age and warrants immediate further evaluation.
Abdominal or diaphragmatic breathing (thoracic breathing) is complete by what age
6 years old especially in females
Which childhood illness is the most common cause of acute lower respiratory infection in first 2 years of life?
On examination a child with asthma will have:
Prolonged expiratory phase.
Is clear voice or crying sounds normal on auscultation
No sounds should be muffled.
Clear sounds are a sign of consolidation in the lungs and requires further evaluation.
`Breathing pattern of the newborn includes
Percussion assists in determining whether underlying tissues are filled with
Not Deep lesions because percussion only penetrates to about 5 - 7 cm.
Recurrent respiratory infections
Large foul smelling stools
A hearty appetite and failure to thrive would indicate what
Need to perform a Sweat Chloride test
The Asthma triad includes
Common complication of flu characterized by crackles
What age group has a transverse:AP chest diameter of 1:1?
Dullness to percussion over lung fields
Whisper pectoriloquy on auscultation
Influenza characterized by what?
Worse over past 12 hours.
Newborn respiratory rate
30 to 60 breaths per minute
Infant weight gain by 6 months
Should double from birth weight
Infant weight gain by 1 year
Should triple birth weight
Linear growth by 1 year
Should be 50% greater so if 20 inches at birth, should be 30 inches at 1 year.
Peri orbital edema
Premature closure of sutures
Collection of blood in the sub ___
Does not cross suture lines.
Flattened occipital area from being positioned supine to much.
THIS SET IS OFTEN IN FOLDERS WITH...
GI & Abd.
Skin - Suturing
GU/Sexuality & Birth control
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