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Review

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Strawberry hemangioma. Skin Findings. to Investigate Further... Persistent acrocyanosis ... on parent's lap? Do not force eye open. Internal Ear Exam (infant) ... – PowerPoint PPT presentation

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Title: Review


1
Review
  • I guide for studying

2
Ground Rules
  • This review is not all-inclusive
  • You are still responsible for
  • Extra notes, comments added in class to clarify a
    concept, etc

3
Wellness Care
  • Fyshs Wellness Schedule
  • Developmental Surveillance (define)
  • Why use screening tools vs. observation?
  • Are parents good judges of developmental delays?
    Why?

4
Age Descriptors
  • Newborn birth to 2 months
  • Infant 0-1 year
  • Toddler 1-2 years
  • Child 2 years

5
History
  • Historian
  • Name
  • Relationship to the patient
  • Reliability

6
Infant Vitals
  • Pulse
  • Apical pulse 5th intercostal space,
    midclavicular line
  • Compare brachial to femoral
  • Respiration
  • Look at abdomen
  • Signs of distress?
  • BP
  • Temp
  • Tympanum vs. axillary (newborn-dont add 1)
  • Height recumbent (top of head to heel)
  • Weight - oz

7
  • Weight
  • Doubles by 6 months
  • Triples by 1 year
  • Head Chest Circumference
  • Where do you measure?
  • lt2 years approx. the same

8
  • Large head hydrocephalus
  • Small head microcephaly
  • (craniosynostosis)
  • Lack of growth, weight gain
  • Failure to thrive?

9
Skin Variants (Pigment? Vessels? Temp? Etc?)
  • Acrocyanosis (transient)
  • Cutis marmorata
  • Mongolian spots
  • Telangiectatic nevi
  • Erythema toxicum
  • Milia/miliaria
  • Strawberry hemangioma

10
Skin Findingsto Investigate Further
  • Persistent acrocyanosis
  • Faun-tail nevus (spina bifida)
  • Café-au-lait (neurofibromatosis)
  • Port-wine stain (opthalmic CN V)
  • Jaundice

11
Jaundice
  • Tips for examining
  • Risk factors
  • Physiologic vs Pathological
  • Rh incompatibility?

12
Immune/Lymph
  • Firm, discrete, moveable (visible)
  • lt0.5cm normal
  • Investigate further if
  • Growing rapidly
  • Suspiciously large (gt2-3 cm)
  • Fixed and immoveable

13
Tonsils
  • Enlarged?
  • At what are do they peak in their relative
    size?
  • Possible complication
  • ____________
  • Grading
  • 2

14
Newborn Head Neck
  • Molding and prominent ridges (birth) usually
    resolved within 1 week

15
Fontanels
  • Post fontanel 2 months
  • Ant fontanel by 24 months
  • Measure transvere AP
  • 2
  • Bulging
  • Infection?
  • Increased ICP?
  • Depressed
  • Dehydration?
  • other signs of dehydration

16
Hydrocephalus
  • Signs Symptoms

17
Eyes
  • Red reflex (newborn )
  • Retinoblastoma
  • Cataracts
  • Strabismus (exo, eso) vs pseudostrabismus
  • Corneal light reflex
  • Cover-uncover
  • Cross Cover
  • Adult visual acuity is developed 6 years (20/20)

18
Nose
  • External
  • Internal
  • Shine a light
  • Tilt the nose tip up with thumb
  • Patency?

19
Infant Mouth Exam
  • Avoid depressing the tongue
  • Stimulates reflex protrusion - unable to visalize
  • Tongue
  • Fits in mouth (macroglossia?)
  • Can protrude past gums (short frenulum?)
  • Strong suck gag reflex
  • Palate well-formed
  • Thrush vs milk?

20
Child Mouth Exam
  • To get a childs mouth open
  • May have to gag them
  • Grading Tonsils (1 to 4)
  • Peak size 2-6 years old

21
Strep pharyngitis
  • S S?
  • NO cough

22
Child Ear Exam
  • Restraining? (red reflex)
  • Sit on parents lap
  • Pull ear down and back OR up and back (child)
  • Pneumatic otoscopy
  • Tympanometry
  • Acoustic reflectometry

23
(No Transcript)
24
Hearing
  • Note Speech development and hearing go hand in
    hand
  • Toys, voice
  • Weber, Rinne, Schwabach
  • 3-4 years old

25
Newborn Chest Exam
  • Periodic breathing
  • Prolonged? Cyanotic?
  • Newborn
  • Cough concern
  • Sneezing normal

26
Chest Exam
  • Crackles
  • Stridor
  • Grunting
  • Increased Respiratory Effort
  • Retraction (ribs, supraclavicular notch)
  • Contraction of SCMs
  • Flaring of nostrils
  • Paradoxic breathing

27
Chest Exam (Child)
  • Breath sounds may be louder, harsher, and more
    bronchial
  • Hyperresonance is common
  • Easy to miss dullness (consolidation)

28
  • Asthma
  • Hyperreactivity
  • COPD
  • Signs and symptoms
  • Anxiety
  • Wheezing
  • Dyspnea
  • Cough
  • Prolonged expiratory phase

29
For each condition
  • Know typical signs symptoms
  • Clinical presentation
  • Expected resolution?
  • Treatment?

30
Infant Heart Exam
  • Heart function
  • Skin
  • Lungs
  • Liver
  • Apical pulse (rate)
  • Brachial vs femoral
  • Weak, thin, bounding?
  • Capillary refill

31
  • Most murmurs are innocent
  • Investigate if
  • Persists beyond 2-3 days of life
  • Intense
  • Fills systole
  • Occupies diastole
  • Radiate widely
  • Cyanosis referral

32
  • Congenital Heart Defects
  • Which ones result in cyanosis?
  • Tetralogy of Fallot

33
Abdominal Exam
  • Infant normal soft rounded
  • If distended? Why?
  • Tympany gas
  • Dullness fluid, solid mass
  • Umbilical hernia (umbilical ring)
  • vs.
  • Diastasis recti (rectus abdominus)

34
  • Detectable spleen
  • Can be common in well infants
  • Liver border
  • Newborn just below R costal margin
  • Infants/toddlers 1-3 cm below
  • Children 1-2 cm below

35
Note
  • Peristaltic waves
  • Pyloric stenosis?
  • Fixed solid mass abdomen
  • Dont palpate aggresively!
  • Wilms (nephroblastoma)
  • Neuroblastoma

36
For each condition
  • Know typical signs symptoms
  • Clinical presentation
  • Significance? Referral?
  • Expected resolution?
  • Treatment?

37
Exam Tips
  • To inspect the infants neck
  • supine, elevate the upper back and let the head
    fall back into extension
  • To encourage an infant to open their eyes
  • Dimly lit room
  • Hold infant upright, suspended, over a shoulder

38
Exam Tips
  • Fundoscopic exam
  • Patient supine
  • Sit on parents lap?
  • Do not force eye open
  • Internal Ear Exam (infant)
  • Supine/prone, head turned
  • Rest ulnar surface of hand (otoscope) against
    face
  • Stabilize head
  • Pull auricle down

39
Exam Tips
  • Auscultating lungs (need deep breaths)
  • Get them active
  • blow out pen light
  • Abdominal Exam
  • Bottle/pacifier/nursing
  • Supine on parents lap
  • If ticklish, place childs hand under yours

40
(There may be more than one answer for each)
  • Clubbing (Schamroth technique)
  • Sign of _________?
  • Child with barrel chest
  • Sign of _________?
  • Skin turgor (abdomen)
  • Sign of _________?
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