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 _________?