Peds Midterm

Macule/patch
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Terms in this set (109)
Macule/patch
flat, circumscribed lesion of any size; usually rounded but may be oval; can be vascular, hyperpigmented or hypopigmented (ex. freckle, mongolian spots, port-wine stain)
Papule
palpable, circumscribed, elevated <1cm (ex. moles, warts)
Plaque
circumscribed, elevated, disc shaped >1cm; commonly formed by confluence of papules (ex. atopic dermatitis, tinea corporis)
Nodule
circumscribed, elevated, usually solid 0.5cm-2cm; may be in epidermis or extend deeper (ex. fibromas, hemangioma)
Cyst
elevated, circumscribed, encapsulated lesion in dermis or subcutaneous layer filled with liquid/semisolid material (ex. acne)
Vesicle
sharply circumscribed, elevated, fluid-containing <0.5cm (ex HSV, herpes zoster)
Bulla
sharply circumscribed, elevated, fluid-containing >1cm (ex. contact dermatitis, burn)
Wheal
distinctive type of solid elevation formed by local, superficial, transient edema; white to pink-pale red in color; blanches with pressure; varies in size and shape (ex urticaria, insect bite)
Comedones
plugged secretions of horny material retained within pilosebaceous follicle; may be flesh-colored, closed (whiteheads), brown/black/open (blackheads)
Burrows
linear lesion produced by tunneling of animal parasite in stratum corneum (ex. scabies)
Telangiectasiafine, irregular, red lines produced by capillary dilation (ex. rosacea)Scaleformed by accumulation of compact desquamation of stratum corneum layers; may be greasy, yellowish, silvery, fine, barely visible or large, adherent, and lamellar (ex. seborrheic dermatitis, psoriasis)Fissuredry, moist, linear, often painful, cleavage from epidermis to dermis that results from marked drying; long-standing inflammation, thickening, loss of elasticity of integument (ex. chronic dermatoses, atopic dermatitis)Lichenificationrough, thickened epidermis secondary to persistent rubbing, itching, or skin irritation; often involves flexor surface of extremity (ex. atopic dermatitis, chronic dermatitis)Scarpermanent fibrotic skin changes that develop following damage to dermis; initially pink/violet, fading to white, shiny, sclerotic area; keloid: pink, smooth, rubbery, often traversed by telangiectatic vessels, increases in size long after healing of lesion, differentiated from hypertropic scars because surface of keloid scar tends to be beyond original wound area (ex. surgery, healed wound, stretch wounds)Crustdried exudate on epidermis composed of serum, blood, or pus overlying a ruptured bulla or vesicle; caused by staphylococcal or streptococcal bacteria (ex. impetigo)Erosionsmoist, slightly depressed vesicular lesion in which all or part of epidermis has been lost; may have surrounding erythema or edema; heals without scarring (ex. candidiasis, MRSA)Purpuraflat but may be palpable; petechiae if pinpoint; does not blanch to pressure; larger areas of bruising may be presentLesion Bordersmay be raised or indurated, as in granuloma annulare and neonatal lupus; or indistinct, as in cellulitis or atopic dermatitisBlaschko Linear Configurationdo not follow any known vascular, nervous, or lymphatic pattern; V and S shaped may represent patterns of neuroectodermal migration, and distribution indicates a cutaneous mosaicismDermatomal/Zosteriform Linear Configurationlines demarcating a dermatome supplied by one dorsal root gangliaSegmental Pattern Configurationthought to be determined by the location of embryonic placodes or other embryonic territories, as in PHACE syndrome (ex. infantile hemangioma)Annular Configurationround, ring shaped where periphery is distinct from the center (tinea corporis or neonatal lupus)Nummular Configurationcoin-shaped with homogenous character throughout (nummular eczema)Targetoid Configurationconcentric ringed often with a dusky or bullous center (erythema multiforme)Herpetiform Configurationclusters of erythematous occasionally scabbed lesions (HSV)Corymbiform Configurationdefined as central cluster surrounded by scattered individual lesions (verrucae)Grade 1 Murmurbarely audible and softer than usual heart soundsGrade 2 Murmurstill soft but about as loud as usual heart soundsGrade 3 Murmurlouder than usual heart sounds but without a thrillGrade 4 Murmurlouder than usual heart sounds and with a thrillGrade 5 Murmurcan be heard with stethoscope barely on chestGrade 6 Murmurcan be heard with stethoscope off chest or with naked earStill's Murmurbetween LLSB and apex; grade 1-3 systolic ejection decreasing with inspiration, upright, or disappearing with valsalva maneuver; low frequency, vibratory, musical in quality; often confused with VSD; 2-7 years oldPeripheral Pulmonic Stenosis Murmuraka newborn pulmonary flow murmur; LUSB with radiation to back and axillae; grade 1-2 systolic ejection, crescendo-decrescendo; premature infants, LBW infants, up to 4 monthsPulmonary Ejection MurmurLUSB; grade 1-3 systolic ejection crescendo decrescendo; heard loudest supine and decreases/disappears with valsalva maneuver; does not radiate; similar to ASD but S2 is normal; 8-14 yearsVenous Hum MurmurRUSB or LUSB below clavicles; grade 1-3 low frequency continuous; loudest when sitting, decreases/disappears when supine; can be increased by turning head away from side, can be obliterated by light jugular vein compression; can be mistaken for PDA; 3-6 year oldsSupraclavicular Carotid Bruit Murmurabove right or left clavicle with radiation to neck; grade 1-3 holosystolic crescendo decrescendo; decreases/disappears with shoulder hyperextension; can be confused with aortic stenosis; common at any ageNormal BPSBP and DBP <90th percentileElevated HTNSBP and/or DBP 90-95th percentile OR BP>120/80Stage 1 HTNSBP and/or DBP >95th percentile on 3 separate occasions OR BP >130/80Stage 2 HTNSBP and/or DBP >95th percentile OR BP>140/90Metabolic Syndrome>90th percentile for obesity, >1.7 triglycerides, <1.03 HDL, BP>130/85, glucose >5.6 or known T2DMVesicular Breath Soundssoft, low pitched sound heard over entire surface of lung; inspiration louder; I>EBronchovesicular Lung Soundsmoderately loud and pitched sounds heard over intrascapular area; heard on inspiration and expiration; I=EBronchial Lung Soundsloud and higher pitched sounds heard over trachea near suprasternal notch; louder on expiration; I<ETrachealloudest and highest pitched sounds heard over trachea; heard on inspiration and expiration; I=ECracklesdiscontinuous sounds, bubbly, heard primarily on inspiration; do not clear with cough; associated with PNA, pulmonary edema, CF; fine= soft and higher pitch, fluid in smaller airways; coarse= loud and lower pitch, fluid in larger airwaysWheezescontinuous, high pitched musical sounds heard primarily on expiration; associated with foreign body aspiration, bronchiolitis, asthmaRhonchicontinuous low pitched sounds; clears with coughing; caused by secretions/mucus in larger airways, bronchitis and asthmaStridorhigh pitched harsh sounds heard primarily with inspiration but can be biphasic; associated with laryngotracheobronchitis, laryngomalacia, subglottic stenosis, vocal cord dysfunctionStertornoisy breathing heard on inspiration and expiration; caused by echoing of soft structures at the level of the nasopharynx and pharynx; can occur with stridor esp when external compression of larynx and supraglottisTympanicloud intensity, high pitch, drumlike, air collection (pneumothorax)Resonantloud intensity, low pitch, hollow (normal lung)Dullmoderate intensity and pitch, dull thud (solid area/mass)Flatsoft intensity, high pitch, very dull (consolidation/PNA)1+ lymph nodesshotty, firm, nontender, 1-1.5cm, requires deep palpation2+ lymph nodesmobile, detectable on superficial to deep palpation, >2-2.5cm3+ lymph nodespalpable superficially, visible on inspection, >3-3.5cm4+ lymph nodeslymph glands are walnut size or larger, nonmobile, tender; skin can be red or warm; >4-4.5cm; visible on inspection1+ tonsilsvisible slightly beyond pillars2+ tonsilsvisible midway between pillars and uvula3+ tonsilsnearly touching the uvula4+ tonsilstouching at midline occluding oropharynx6 months languagemakes sounds like "da" and "ba"'; makes high pitched squeals; turns in direction of loud noise6 months gross motorrolls from back to stomach; sits with support of own hands; bears weight with feet flat on surface6 months fine motorgrabs toys; picks up small toy with one hand; reaches for crumb with thumb or raking motion6 months cognitivereaches or grasps toy using both hands; looks for fallen object; picks up toy and mouths it6 months socialsmiles or coos in front of mirror; grabs own foot while lying on back; tries to get toy out of reach12 months languagemakes 2 similar sounds; "ba ba" or "da da"; plays peek a boo; says 3 words; points to objects12 months gross motorwalks holding on to furniture or holding both your hands; stands alone12 months fine motorpicks up string; uses pincer grasp; throws ball with forward arm motion; turns pages of book12 months cognitiveclaps two toys together; looks for hidden object; copies scribbles on paper12 months socialhelps with dressing; rolls or throws a ball; hugs stuffed animal or doll18 months languagepoints to objects and pictures in book; says 8 or more words; imitates 2 word sentence18 months gross motorpicks up object from floor; walks; climbs; walks down stairs; kicks large ball18 months fine motorthrows small ball; stacks 2-3 blocks; marks paper; turns pages of book; uses spoon18 months cognitivedumps things out of container; copies single line drawing18 months socialgets attention by pulling on hand or clothes; comes to you for help; drinks from cup; copies activities2 years languagepoints to correct picture in book; imitates 2 word sentence; follows directions; names objects2 years gross motorwalks down stairs holding rail; kicks large ball; runs; jumps with both feet2 years fine motoruses spoon without spilling; turns pages of book; flips switches on and off; stacks 7 blocks; string beads2 years cognitivecopies line drawing; pretends play; puts things away; climbs on chair to reach object2 years socialdrinks from cup without spilling; copies activities such as sweep or comb hair; pushes toys on wheels3 years languagepoints to 7 body parts; speaks with 3-4 word sentences; follows directions; identifies action in picture book; knows own first and last name3 years gross motorkicks ball by swinging leg forward; jumps forward at least 6 inches; walks up stairs; stands on one foot for 3-5 seconds; throws ball overhand3 years fine motordraws line in vertical direction and circle; strings beads; cuts paper; holds crayon between fingers and thumb3 years cognitivelines up 4 objects in a row; repeats 2 numbers; makes a bridge with blocks3 years socialpushes and steers wagon or toy on wheels; dresses self; knows sex; takes turns4 years languagefollows simple directions; follows 3 directions; speaks in complete sentences4 years gross motorjumps forward at least 6 inches; catch a large ball with both hands; climbs a ladder4 years fine motortraces a circle; cuts paper with scissors; puts together 5-7 piece puzzle4 years cognitiverepeats 3 numbers; identifies small versus large circle; pretends play4 years socialdresses self with coat and shirt; takes turns; serves self food; washes hands using soap and water5 years languagefollows 3 unrelated directions; uses 4-5 word sentences; used past tense and comparison words; answers questions5 years gross motorthrows ball at least 6 feet away; catches large ball with both hands; stands on one foot for 5 seconds; walks on tiptoes for 15 feet; hops on one foot 4-6 feet; skips5 years fine motordraws picture of person with 3 or more body parts; cuts with scissors; copies shapes and letters; prints first name5 years cognitiveidentifies colors; counts up to 15; knows opposites; names 3 numbers and 4 letters5 years socialserves self food; washes and dries hands and face without help; knows phone number and city of residence; dresses and undresses self; uses toilet by self; takes turns and shares with others3 month red flagsrolling over prior; persistent fisting; failure to alert to environmental or visual/auditory stimuli4-6 month red flagspoor head control while sitting; failure to reach for objects; no social smile; lack of fixation or visual tracking; failure to turn to sound or voice6-12 month red flagspersistence of primitive reflexes; inability to sit; no babbling; no reciprocal vocalizations; inability to localize sound; absent stranger anxiety12-18 month red flagsnot verbalizing consonant; hand dominance before; lack of imitation; simple commands not understood; lack of pointing; advanced non-communicative speech; inability to walk independently18-24 month red flagsno two word sentences; no word other than mama/dada; unable to follow simple commands; cannot name one picture in book; echolalia beyond; does not associate toys with function; inability to walk up or down stairsinfant (birth to one year)trust vs mistrusttoddler (1 to 3 years)autonomy vs shame and doubtpreschooler (3-6 years)initiative vs guiltschool-age child (6-12 years)industry vs inferiorityadolescent (12-21 years)identity vs role confusion