Physical Exam Flashcards
(136 cards)
1
Q
Newborn
A
birth-2mo
2
Q
Infant
A
0-1yr
- neonatal: 1-28 days
- postneonatal: 29 days-1 year
3
Q
Toddler
A
1-2yr
4
Q
Child
A
2+ years
5
Q
What is the purpose the Apgar Score?
A
assess neurologic recover from birth and adaptation to extrauterine life
6
Q
What are the components of the Apgar score?
A
- heart rate
- respiratory effort
- muscle tone
- reflex irritability
- color
7
Q
What does Apgar stand for?
A
- Activity
- Pulse
- Grimace
- Appearance
- Respiration
8
Q
What is a normal Apgar score at 1 minute?
A
8-10
9
Q
An Apgar score of ___ indicates some nervous system depression.
A
5-7
10
Q
An Apgar score of ___ indicates severe depression requiring immediate resuscitation.
A
0-4
11
Q
What is a normal Apgar score at 5 minutes?
A
8-10
12
Q
Preterm
A
<37 wks
13
Q
Term
A
37-42 wks
14
Q
Postterm
A
> 42 wks
15
Q
Preterm Appropriate for gestational age infants are more prone to…
A
- respiratory distress syndrome
- apnea
- patent ductus arteriorsus
- infection
16
Q
Risks for Large for gestational age infatns
A
- birth difficulties
- metabolic abnormalities shortly after birth
17
Q
What is a risk factor for an infant to be LGA?
A
maternal diabetes
18
Q
Newborn Exam sequence
A
- observation
- head, neck, thorax, abdomen, genitourinary system
- LE, back
- ears, mouth when open
- skin, as you go
- neurologic system
- hips
19
Q
What is paradoxic breathing?
A
when the chest moves inward during inhalation instead of expiration
20
Q
What is the Flush Technique?
A
a way to measure BP in infants
==>empty vessels and release pressure slowly until arm “flushes” to usual color
21
Q
What happens if the cuff is too wide or too narrow?
A
wide: underestimate BP
narrow: artificially high BP
22
Q
What are the most accurate temperature readings in a newborn?
A
rectal or axillary
==> children >5 inc axillary reading by 1 degree
23
Q
How should you measure an infant?
A
from top of head to heel with the foot dorsiflexed
24
Q
When is the head circumference taken?
A
every “health visit” yoa
25
What is measured for head circumference?
largest circumference
| ==>glabella to EOP
26
Where do you measure chest circumference?
measure around the nipple line to the nearest 1/8th
27
Breastfed infants correlate more with ___ growth rates.
WHO
28
Formula infants correlate more with ___ growth rates.
CDC
29
What is the average birth weight?
5lbs 8oz- 8lb 13oz
30
What is the average length at birth?
18-22 in
31
What is the average birth head circumference?
13-14 in
32
How much does length increase within the 1st year of life?
50%
33
What are the weight increments in the first year?
double by 6 months
| triple by 1 year
34
Head & chest circumference newborn to 5 months
head may equal or exceed chest by 2cm
35
Head & chest circumference 5 months to 2 years
chest should closely approximate head
36
Head & chest circumference > 2 years
chest should exceed head
37
Growth patterns: infancy
- trunk predominates
| - fat inc until 9mo
38
Growth patterns: childhood
- legs grow faster
| - slow fat until 7 prepubertal fat
39
Growth patterns: adolescence
- trunk and legs elongate
- 50% ideal weight gained
- skeletal mass and organs double in size
40
What is primary hydrocephalus?
sutures do not close
41
What is secondary hydrocephalus?
brain does not grow
42
Transient mottling when infant is exposed to dec temperature
cutis marmorata
43
When should an underlying cardiac defect be considered with the presence of acrocyanosis?
if it is persistent or more intense in the feet than hands
44
vernix caseosa
- mixture of sebum and skin cells
| - protective
45
Flat, deep pink patch seen in back of neck
telangiectatic nevi
| "stork bite"
46
Irregular areas of blue/gray pigmentation usually in sacral/gluteal regions
dermal melanocytosis
47
Pink papular rash with vesicles superimposed
erythema toxicum
| -inability of the liver to get rid of toxins
48
When does jaundice become worrisome?
if it descends below the nipples (>12 mg/dl)
49
Physiologic Jaundice
-
- inability of liver to conjugate bilirubin
- present in 50%
- disappears in 8-10 days
50
What is the most likely cause of nail clubbing?
cardiovascular disease
51
What technique is used to check for nail clubbing?
Schamroth Technique
52
What are milia?
- small, white papules on face
| - plugged sebaceous glands
53
What is miliaria?
- heat rash
| - occlusion of sweat ducts
54
Where is eczema MC seen in younger children?
FACE, elbow, knees
55
Faun tail nevus can be associated with ___?
spina bifida occulta
56
What can facial port-wine stain be associated with if it involves the ophthalmic division of CN V?
Sturge-Weber Syndrome
57
Postauricular and occipital lymph nodes are common up until what age?
2 years
58
Cervical and submandibular lymph nodes are common at what age?
after 2 years
59
What are the MC symptoms for Mono in children?
fever, HA, tummy ache with the absence of a cough
60
Subcutaneous edema that crosses suture lines, is soft and is MC seen in the occiput or presenting part?
Caput Succedaneum
61
Subperiosteal bleed that does not cross suture lines, is firm and is MC seen in the parietal region?
Cephalhematoma
62
What is the MC type of craniosynostosis?
```
sagittal synostosis
(most rare = lambdoid)
```
63
What are some characteristics of lambdoid synostosis?
- flattening of affected side
- inc. ipsi mastoid growth
- ear migrates back on affected side
64
Posterior fontanel closes by ___?
2 months
65
Anterior fontanel closes by ___?
24 months
66
How large should the transillumination ring be in all regions of the head?
<2cm
| occiput = <1cm
67
Setting sun sign is seen in what condition and what it the cause?
Hydrocephalus
| ==>paresis of superior rectus muscle
68
Craniotabes can be associated with which conditions?
- rickets
- hydrocephalus
- premature infants
69
What are some characteristics of Fetal Alcohol Syndrome?
- smooth philtrum
- widespread eyes
- hirsute forhead
- short nose
- thin upper lip
70
What is Hypertelorism?
widely spaced eyes
| ==>may be associated with mental retardation
71
What are Brushfield spots?
small gray specks in a circular pattern in the iris; associated with Down's syndrome
72
In a cross-cover test, you expect the exotropic eye to move ___?
lateral to midline
73
In a cross-cover test, you expect the esotropic eye to move ___?
medial to midline
74
In a cross-uncover test, you expect the exotropic eye to move ___?
lateral
75
In a cross-uncover test, you expect the esotropic eye to move ___?
medial
76
What is Amblyopia?
reduced vision in an eye that appears structurally normal
77
What is Duane Syndrom?
-congenital non-progressive horizontal ophthalmoplegia due to agenesis of abducens nucleus
78
A Snellen result of what may indicate amblyopia in a child?
2 line difference between eyes
79
Congenital Cataracts requires what type of workup(s)?
- metabolic
- infectious
- systemic
- genetic
80
What are some common causes of congenital cataracts?
- TORCHS
- hypoglycemia
- trismoies
- prematurity
81
Retinopathy of Prematurity increases the risk of?
- retinal detachment
- glaucoma
- blindness
82
How does the external auditory canal differ in an infant compared to an adult?
it is shorter and has an upward curve
| pull downward
83
The tip of the auricle should line up with which two landmarks?
outer canthus and EOP
84
What is the MC infection of the middle ear in children?
bacterial otitis media
85
What are some long term issues with chronic otitis media w/effusion?
delayed speech development
86
Which sinuses are the first to develop?
maxillary and ethmoid
87
When does the frontal sinus develop?
by 7-8 years
88
What is the MC symptom in a 3 year old with a sinus infection?
bad breath
89
Why should you not use a tongue depressor in an infant?
stimulates "tongue thrust reflex"
90
Which teeth normally come in first?
front lower incisors
91
Complete cleft palate includes which structures?
lip, hard palate, soft palate and into nasal cavity
92
What is a peritonsillar abscess?
infection of the tissue between tonsil and pharynx
93
What should you not use on a child that has epiglottitis?
tongue depressor b/c it can trigger more muscle spasms
94
When is epiglottitis MC?
3-7 years of age
95
What are some characteristics of epiglottitis?
- sudden high fever
- drooling
- tripod position
- sore throat
96
What could be indicative of a relatively larger chest circumference?
poorly controlled gestational diabetes
97
If chest roundness persists after 2 years of age, what should you suspect?
chronic obstructive pulmonary problem
==>cystic fibrosis (MC)
==>chronic asthma
98
Autosomal recessive disease of exocrine glands
cystic fibrosis
99
What is the normal distance between the nipples?
1/4 of the chest circumference
100
What is the average respiratory rate in an infant?
40-60 rpm
101
What are some indicators of increased respiratory effort?
- retraction of supraclavicular notch
- SCM contraction
- flaring of nostrils
- intercostal retractions
- tachypnea
102
What is laryngomalacia?
when the cartilage of the larynx is not fully developed = "floppy"
103
What is the MC causes bronchiolitis?
respiratory syncytial virus (RSV)
104
When is bronchiolotitis MC?
<6 months
105
When is croup MC and what gender does it MC affect?
1 1/2 - 3 years; boys
| parainfluenza virus
106
During what part of the day does croup come on?
at night after child has gone to sleep
107
How long after birth does the foramen ovale and ductus arteriosus close?
24-48 hrs
108
What is characteristic of a patent ductus arteriosus?
machinery murmur
109
What is a potential complication of a patent ductus arteriosus?
right sided heart failure
| fatigue, no cyanosis
110
What is a finding commonly found in infants with congestive heart failure?
an enlarged, firm liver
111
Which heart condition will always cause cyanosis at birth?
transposition of the great vessels
112
What is the normal capillary refill time in a newborn?
<1 second
prolonged = >2 sec.
(dehydration, hypovolemic shock)
113
How do you determine amplitude and pulse count in an infant?
palpate apical impulse for amplitude and listen for pulse count
114
What are some conditions that can shift the apical impulse?
- pneumothorax
- diaphragmatic hernia
- dextrocardia
115
What is sinus invertus?
heart and stomach are on the right, liver on the left
116
What are some causes of a weak or thin pulse?
- decreased CO
| - peripheral vasoconstriction
117
What are some dDx for a bounding pulse?
L to R shunt (PDA)
118
What is a dDx for a difference in pulse amplitude between femoral and radial?
coarctation of the aorta
119
How much does HR increase with temp. increase?
10-20 beat inc. for each degree inc
120
What are the 4 "S's" for Innocent murmurs?
- short (2-3 days)
- soft (grade I or II)
- systolic
- no other signs/symptoms
121
What are the top 3 dDx for HTN in a child?
- kidney disease
- renal artery stenosis
- coarctation of aorta
122
Which one is the MC heart defect in an infant?
tetralogy of fallot
123
What is involved in tetralogy of fallot
-pulmonary valves stenosis
-overriding aorta
-RV hypertrophy
-VSD
(ASD)
124
What are Tet spells?
central cyanosis, paroxysmal dyspnea with loss of consciousness
125
What is rheumatic fever?
complication of strep. pharangitis or skin infxn
126
What can be implicated with rheumatic fever?
mitral or aortic valves
127
What is Jone's Criteria for rheumatic fever diagnosis?
presence of 2 major manifestations or 1 major + 2 minor manifestations
128
What are the major manifestations of rheumatic fever?
```
carditis
polyarthritis
chorea
erythema marginatum
subcutaneous nodules
```
129
What is kawasaki disease?
acute illness (fever) MC affecting young boys under 5
130
What is the medical management of kawasaki disease?
intravenous gamma globulin and/or aspirin
131
What is a dDx in a child with spider nevi?
liver disease
132
What is granulomatous tissue?
serous or serosanguinous dishcarge once the stump has been separated from umbilicus
133
What is the MC intraabdominal tumor of childhood?
Nephroblastoma (Wilm's Tumors)
134
What is a neuroblastoma?
a mass in the adrenal medulla
135
What would you suspect if you found a sausage-shaped mass in the left or right upper quadrant?
intussusception
136
When is intussusception MC?
3-12 months old
