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178 Cards in this Set
- Front
- Back
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What is the current recommendation regarding spinal checkups for infants? pre-schoolers? school-aged children? (p. 2)
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*for infants in the first 2 years of life, at least every month
*for pre-school children, at least every 2 months *for school-aged children, at least every 3 months |
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...a flexible, continuouys process whereby knowledgeable professionals perform skilled observations of children during the provision of health care. (p. 2)
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Developmental surveillance
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What elements does developmental surveillance include? (p. 2)
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* Eliciting and attending to parental concerns
* Obtaining a relevant developmental history * Making accurate and informative observations of children * Sharing opinions and concerns with other relevant professionals |
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What is the rule regarding physicals in the state of Iowa? (from lecture)
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Can perform on school-aged children, but chiropractors cannot perform for daycare
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What are the benefits of performing a developmental surveillance? (p. 3)
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* Communicates interest in the child's overall development (not just his or her physical health)
* Increases parent satisfaction |
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Why should chiropractors use screening tools? (p. 3)
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1. State norms explicitly
2. Help as a reminder to observe development 3. Efficient way to record the observations 4. Help identify more children with delays |
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What is the chiropractor's role in screening according to AAP guidelines? (p. 4)
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As primary care doctors we should:
* Participate in developmental surveillance * Utilize parental report tools * Provide for adequate follow-up * Refer to appropriate community programs |
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More errors are made because of inadequate ________ and _________ than any other cause. (p. 5)
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history-taking, superficial exam
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What are definite no-no's when working with children? (p. 5)
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* Never be critical of another practitioner's diagnosis or treatment suggestions
* Never allow a child who has been brought to you for care to leave without it -- Do what you have to do, despite protests from the child * Never allow a child to be rewarded for being sick |
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How is the chief complaint handled differently when working with children? (p. 6)
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It may be taken from the parent or guardian
-- Note the name, relationship & reliability of the person providing the history -- The child should be included as much as possible (appropriate for his/her age |
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What elements should be included in the past medical history? (p. 7)
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* Mother's health during pregnancy
* Birth * Neonatal period - first month of life * Feeding * Development * Illnesses |
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When reviewing the past medical history with regards to mother's health during the pregnancy, what elements should be reviewed? (p. 7)
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* General health, extent of prenatal care
* Specific diseases or conditions (i.e., infectious diseases, weight gain, edema, hypertension, proteinuria, bleeding, pre-eclampsia) * Medications, hormones, vitamins, special or unusual diet *Quality of fetal movement; time of onset * Emotional and behavioral status (attitudes toward pregnancy and children) * Radiation exposure * Use of alcohol or elicit drugs |
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When reviewing the past medical history with regards to the birth, what elements should be reviewed? (p. 7)
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* Duration of the pregnancy
* Place of delivery * Labor --Spontaneous or induced --duration --analgesia or anesthesia --complications * Delivery --presentation --forceps, vacuum extraction --vaginal or cesarean section --complications * Condition of infant, onset of cry, APGAR scores (if available) * Birth weight of infant |
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When reviewing the past medical history with regards to the neonatal period, what elements should be reviewed? (p. 7-8)
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* Congenital anomalies
* Baby's condition in hospital, oxygen requirements, color, vigor, cry, feeding * Duration of baby's stay in hospital; infant discharged with mother? * Bilirubin phototherapy * Prescriptions (antibiotics) First month of life: * Jaundice, color * Vigor of crying * Bleeding * Convulsions * Other evidence of illness |
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When reviewing the past medical history with regards to development, what elements should be reviewed? (p. 8)
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* Commonly used developmental milestones (baby books and photographs can help parent's stimulate recall)
* Age when able to... --Hold head erect when in a sitting position --Roll from front to back; back to front --Sit alone; unsupported --Stand with support; without --Use words --Talk in sentences --Dress self * Age when toilet trained * Dentition --Age of first teeth --Loss of deciduous teeth --Eruption of first permanent teeth * Growth * Sexual, any concerns with present status --Female: breast development, sexual hair, acne, menstruation (description of menses) --Male: sexual hair, voice changes, acne, nocturnal emissions * School (grade, performance problems) |
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When reviewing past medical history with regards to illnesses, which elements should be reviewed? (p. 9)
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* Vaccinations
* Communicable diseases * Injuries * Hospitalizations |
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What elements should be included when taking a family history? (p. 9)
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* Maternal gestational history
- List all pregnancies --Health status of living children --Deceased children: date, age, and cause of death --Miscarriage: dates and duration of pregnancies * Age of parents at the birth of this child ***Review at least 2 generations on each side of the family |
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What elements should be included when taking a personal and social history? (p.9)
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* Personal status
--Nail biting, thumb sucking, breath holding, temper tantrums, pica, tics, rituals, etc... --Bed wetting, constipation, or fecal soiling of pants --School adjustment * Home conditions --Father's and mother's occupations --Principal caretaker of the child --Parents divorced or separated? --Food prepared by whom? --Sleep habits; sleep arrangements |
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What do the acronyms "HEADS" and "PACES" refer to in regards to common adolescent issues? (p. 10)
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HEADS...
H Home E Education A Activities, affect, ambition, anger D Drugs S Sex PACES... P Parents, peers A Accidents, alcohol & drugs C Cigarettes E Emotional issues S School, sexuality |
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What ages are associated with the terms "Newborn", "Infant", "Toddler" and "Child"? (p. 11)
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Newborn = birth to 2 months
Infant = 0-1 year Toddler = 1-2 years Child = 2+ years |
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Where should you take a pulse on a baby? (p. 11)
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* Apical pulse
-- 5th intercostal space in the midclavicular line * Femoral pulse --Use a point halfway from the pubic tubercle to ASIS as a guide |
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What is the trend with regard to pulse rate with kids as they age? (p. 11)
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120-170 as a newborn then gradually drops to 70-110 by 10 years of age
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Where do you count respiration on an infant? (p. 11)
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With the rise and fall of the abdomen, not the chest as in adults
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What is the normal respiration rate in a newborn? (p. 12)
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30-80 breaths per minute (adult is 12-20 breaths)
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Where is a good place to take the temperature on an infant? (p. 12)
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In the armpit - axillary temp correlates well with core temp due to the infant's small body mass and uniform skin blood flow
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What are some things you can do to get started on an Pediatric Exam? (p. 61)
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1)Offer toy or paper/pencil; ask child to draw shapes and ask questions to assess development and mental status
2) General inspection in the waiting room 3) Vitals done first - make them fun, build rapport |
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What are some ways to assess NMS exams while the child is playing? (p. 61)
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1) Observe spontaneous activities
2) Ask them to demonstrate skills: building blocks, drawing shapes 3) Evaluate gait, jumping, hopping, ROM 4) Muscle strength: climbing on parent's lap, stooping, etc. |
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Benefits of parent's lap include: (p. 61)
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1) Feel more secure
2) observe parent/child relationship |
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Describe UPPER Extremity evaluation done while the child is on the parent's lap. (p. 61)
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Inspect arms (movement, size, shape), observe use of hands (number of fingers, palmer creases), palpate radial pulses, biceps and triceps reflex, BP
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Describe LOWER Extremity evaluation done while the child is on the parent's lap. (p. 61)
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Inspect legs (movement, size, shape, alignment, lesions), Inspect feet (alignment, longitudinal arch, number of toes), Dorsal pedis pulse, plantar reflex, achilles and patellar reflexes
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Describe HEAD & NECK evaluation done while the child is on the parent's lap. (p. 62)
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Inspect head (shape, alignment with neck, hairline, position of auricles), palpate fontanels, sutures, depressions, measure head circumference, inspect neck (voluntary movement, webbing). Palpate neck (trachea, thyroid, muscle tone, lymph nodes
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Describe CHEST, HEART & LUNG evaluation done while the child is on the parent's lap. (p. 62)
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Inspect chest (size, shape, deformity, nipple and breast development, respiratory movement, precordial movement), palpate Ant. chest (maximal impulse, tactile fremitus) Auscultate lungs and count respiration, Auscultate heart (murmurs, count apical pulse)
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Describe "SUPINE" evaluation done while the child is on the parent's lap. (p. 62)
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Diaper Loosened
Abdomen (inspect, bowel sounds, palpate liver size etc; percuss), Femoral pulse (vs Radial), Lymph nodes, external genitalia |
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Describe evaluation performed while the child is STANDING (p. 62)
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Ovserve posture, Adam's test, Gait
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Fundoscopic and Otoscopic Exams (p. 62)
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RESTRAIN A CHILD ONLY AS A LAST RESORT!
Lesses the fear: Let child CAREFULLY handle the instrument, "blow out" the light, perform the test on a doll or parent |
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Additional exams on the head with the fundoscope and otoscope while sitting on parents lap (p. 62)
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Inspect eyes (extraocular movements, pupillary light reflex, red reflex, funduscopic exam) otoscopic exam, inspect nasal mucosa, inspect mouth and pharynx
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Hirschsprung Disease
AKA: Congenital Aganglionic Megacolon (p. 58) |
Avsense of parasympathetic ganglion cells in a segment of the colon.. NO PERISTALSIS
Newborn: May fail to pass meconium in the first 24-48 hrs |
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Meconium (p. 58)
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First Bowel Movement after birth
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Define how to identify Intussusception through palpation (p. 58)
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Sausage-shapped mass in the left or right upper quadrant
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Intussusception (p. 58)
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INTESTINAL OBSTRUCTION: prolapse of one segment of intestine into another
MC: 3-12 months Unknown etiology Signs & Symptoms: Acute intermittent ab pain, ab distention, vomiting, stools mixed with blood and mucus (red current jelly appearance), sausage shaped mass in R or L upper quadrant, R lower quadrant feels empty (Dance Sign) |
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Intussusception "ABCDEF" (p. 58)
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A - Abdominal or Anal "sausage"
B - Blood from the rectum C - Colic: Babies draw up their legs D - Distention, Dehydration and shock E - Emesis F - Face pale |
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Pyloric Stenosis (p. 59)
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Olive-Shaped mass in the right upper quadrand (deep palpation) immediately after the infant vomits
Hypertrophy of the circular muscle of the pylorus or obstruction of the pyloric sphincter Signs & Symptoms: regurgitation (projectile vomit), feeding eagerly (even after vomiting), failure to gain weight, dehydration, small rounded mass palpable in the R upper quadrand (esp after the child vomits) |
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Gastroesophageal Reflux (GER) (p. 59)
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Relaxation of incompetence of the lower esophagus persisting beyond the newborn period.
Signs and Symptoms: Regurgitation & vomiting, weight loss and failure to thrive, respiratory problems (aspiration), bleeding from esophagitis |
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Tips - Abdomen Exam (p. 54)
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1) Relaxation & quiet: bottle/on parents lap
2) Use the respiratory cycle: abdomen soft during inspiration 3) Ticklish: use FIRM touch 4) Difficult to detect tenerness and pain: distract child with a toy, start away from suspected area, observe for changes |
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Abdomen Inspection (p. 54)
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1) Movement with Respiration
2) Shape 3) Contour 4) Pulsations (common in infants) |
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Distended veins dDx (p. 54)
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vascular obstruction
abdominal distension abdominal obstruction |
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Spider nevi dDx (p. 54)
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liver disease
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Infant abdomen shape (p. 54)
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Should be ROUNDED and DOME shaped
Distended? feces, mass, organ enlargement Scaphoid? abdominal contents are displaces |
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Toddler Abdomen shape (p. 55)
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Pot-Bellied
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Abdomen shape after age 5 (p. 55)
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may become concave when laying supine
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Respiration continues to be abdominal until what age? (p. 55)
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6-7 years
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Umbilical stump (p. 55)
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should be dry and odorless
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Inspect all skin folds in the abdomen for: (p. 55)
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discharge
redness induration skin warmth granulomatous tissue |
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Granuloma (p. 55)
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*Serous or serosanguinous discharge once the stump has separated
*no other signs of infection |
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Describe the Umbilicus (p. 55)
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usually INVERTED (everts with increased abdominal pressure)
note any protrusion: may be hernia or diastasis recti |
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Umbilical Hernia (p. 55)
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protrusion of omentum and intestine through the umbilical opening
COMMON in infants Max size by 1 month generally closes spontaneously by 1-2 years Measure DIAMETER, not length Should "reduce" with light pressure (like a water balloon.. unless it pops) |
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Diastasis Recti (p. 55)
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MIDLINE SEPARATION (1-4cm) of the rectus abdominus
b/w xiphoid and umbilicus No need to repair, usually resolves by 6 years of age |
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Peristaltic Waves (p. 56)
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use tangential lighting & observe abdomen at eye level
dDx: malnutrition or obstruction |
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Abdominal Exam: Auscultation (p. 56)
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peristalsis ("metalic tinkling") every 10-30 seconds
Bowel sounds should be present 1-2 hours after birth NO bruits or venous hum should be detected |
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Abdominal Exam: Light Palpation (p. 56)
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Knees flexes, place hand gently on abdomen, gradually increase pressure
ID: spleen, liver, masses close to the surface |
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Light Palpation: Spleen (p. 56)
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1-2cm below the L costal margin
palpate the first few weeks after birth Increased spleen size may indicate: blood dyscrasias, septicemia |
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Light Palpation: Liver (p. 56)
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Liver Scratch Test
Newborn: just below R costal margin Infants & Toddlers: 1-3cm below Children: 1-2cm below |
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Hepatomegaly (p. 56)
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Lower border is GREATER than 3cm below the R costal margin
May indicate: infection, cardiac failure, liver disease |
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Abdominal Exam: Deep Palpation (p. 56)
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Palpate all quadrants for masses
Location, Size, Shape, Tenderness, Consistency |
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Transillumination (p. 56)
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Used to distinguish cystic from solid masses
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Suspicion of neoplasm (p. 57)
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LIMIT PALPATION OF THE MASS!!
MAY CAUSE INJURY OR SPREAD OF MALIGNANCY |
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Abdominal Exam: Deep Palpation - Fixed masses should be investigated with special studies if _______, _______ or _______ (p. 57)
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laterally mobile
pulsatile (palpate the aorta for signs of enlargement) located along vertebral column |
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NEPHROblastoma
AKA: Wilms Tumor (pg. 57) |
MC INTRAABDOMINAL TUMOR OF CHILDHOOD.
2-3 years of age MALIGNANT: Firm, non-tender, deep mass. only slightly moveable. doesn't usally cross midline, sometimes bilateral Possible: low grade fever, hypertension |
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NEUROblastoma (p. 57)
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NOT very common
Frequently appears as a mass in the ADRENAL MEDULLA Malignancy in early childhood: firm, fixed, non-tender, irregular and nodular abdominal mass, malaise, loss of appetite, weight loss, protrusion of eyes May metastasis to adjacent organs |
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Abdominal percussion (p. 57)
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May be MORE tympanic than adults.
swallow air when feeding and crying |
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abdominal tympany with distended abdomen (p. 57)
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Gas
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abdominal DULLNESS WITH DISTENDED ABDOMEN (p. 57)
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Fluid, solid mass
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Examination of the bladder (p. 57)
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Palpate and percuss over the suprapubic area
determine size distention? |
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Rebound Tenderness Exam - Tips to keep in mind when assessing a child (p. 57)
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OBSERVE the child's facial expression and pupils
BE CAUTIOUS -- once a child has experienced palpation that is too intense, a subsequent examiner has little chance for easy access to the abdomen. |
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What is the best way to measure height of a baby that is not able to support its own weight? (p. 12)
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Infant measuring mat or mark a sheet of headrest paper
--Measure from the top of the head to the heel (foot dorsiflexed) 1. Tear a length of headrest paper 2. Lay the child on top of the paper 3. Mark the top of the child's head 4. Ask mother to hold child in place 5. Extend leg and mark under the heel (foot dorsiflexed) |
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How do you measure a child who is old enough to stand without support (24-36 months)? (p. 13)
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"Stature Measuring Device"
* Heels, buttocks and shoulders against the wall * Looking straight ahead -- Outer canthus of the eye should line up with the external auditory canal |
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How do you measure the weight of an infant? (p. 13)
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Infant platform scale
-- more accurate (measures in ounces or grams) |
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How do you measure head circumference? (p. 13)
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* Measure the largest circumference with the tape snug
-- Occipital protuberance to the supraorbital prominence (EOP to Glabella) |
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How often do you need to measure the head circumference? (p. 13)
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Done at every "health visit" until 2 years of age; yearly from 2-6 years of age
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How do you measure the chest circumference? (p. 13)
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Measure around the nipple line to the nearest 1/8 in (0.5cm)
-- Firmly but not tight enough to cause an indentation in the skin --Head and chest circumference should be about equal through age 2 |
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How do you record the growth measurements you take on children? (p. 13)
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Chart on appropriate growth curve for sex and age
*identify the infant's percentile *Note any change or variation from the population standard or the child's norm |
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What are the average measurements at birth? (p. 14)
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Average weight: 5lb 8 oz - 8 lb 13 oz
Average length: 18-22 in (45-55cm) Head circumference: 13-14 in (33-35 cm) *Most babies born to the same parents weigh within 6oz of each other at birth -- Lower birth weight: consider an undisclosed congenital abnormality or intrauterine growth retardation |
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What is the expected growth of a baby within the first few years? (p. 14)
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* Length increases by 50% in the 1st year of life
* Weight doubles by 6 months, triples by 1 year * Head & chest circumference -- Newborn to 5 months: Head may be equal or exceed the chest by 2cm -- 5 months to 2 years: Chest should closely approximate the head circumference -- >2 years: Chest should exceed head circumference |
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What are the growth patterns in infancy? (p. 14)
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* Growth of the trunk predominates
* Fat increases until 9 months of age |
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What are the growth patterns in childhood? (p. 14)
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* Legs are the fastest growing body part
* Weight is gained at a steady rate * Fat increases slowly until 7 years of age when a prepubertal fat spurt occurs before the true growth spurt |
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What are the growth patterns in adolescence? (p. 14)
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* Trunk and legs elongate
* About 50% of the ideal weight is gained * Skeletal mass and organ systems double in size |
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What are gender difference between males and females with regard to growth? (p. 14)
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Males: Broader shoulders & greater musculature. Slight increase in body fat during early adolescence BEFORE the gain in lean tissue
Females: Wider pelvic outlet. Persistent increase in fat throughout adolescence, occuring AFTER the peak growth spurt |
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* Failure of an infant to grow at "normal rates"
* May be related to: - Chronic disease - Congenital disorder (brain, heart, kidney) - Inadequate calories and protein - Improper feeding methods - Intrauterine growth retardation - Emotional deprivation (growth hormone levels will be low) (p. 14) |
Failure to Thrive
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What is the danger if head circumference increases rapidly or rises above percentile curves? (p. 15)
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* Increased intracranial pressure
--dDx: Hydrocephalus |
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What is the danger if head circumference grows slowly or falls off percentile curves? (p. 15)
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* Microcephaly
-- dDx: Craniosynostosis |
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What congenital syndromes are associated with short stature? (p. 15)
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Down Syndrome & Turner Syndrome
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What are some expected variants with regard to newborn skin? (p. 16)
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* Transient puffiness of the hands, feet, eyelids, legs, pubis, or sacrum occurs in some newborns
* Some newborns are bald while others are born with an inordinate amount of hair * Dark-skinned newborns do not always manifest the intensity of melanosis that will be readily evident in 2-3 months (Exceptions: nail beds and skin of the scrotum) * Skin may look very red the first few days of life -- Skin color is partly determined by subcutaneous fat |
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Transient mottling when infant is exposed to decreased temperature ( adapting to a cold environment--considered harmless) (p. 16)
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Cutis marmorata
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Cyanosis of hands & feet. Considered normal if it is transient. An underlying cardiac defect should be suspected if it is persistent or more intense in the feet than hands. (p. 16)
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Acrocyanosis
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*Whitish, moist, cheese-like substance
--Mixture of sebum and skin cells * Covers the infant's body at birth * Protective (p. 16) |
Vernix Caseosa
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* Fine, silky hair covering the newborn shoulders and back
* Shed within 10-14 days (p. 16) |
Lanugo
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"Stork bites"
-Flat, deep pink, localized areas usually seen in the back of the neck. (p. 16) |
Telangiectatic nevi
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*Irregular areas of deep blue pigmentation usually in sacral and gluteal regions
--Seen predominantly in African, Native American, Asian or Latin descent (p. 17) |
Mongolian spots
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* Pink, papular rash with vesicles superimposed
- thorax, back, buttocks and abdomen ( May appear 24-48 hrs after birth and resolves after several days (p. 17) |
Erythema toxicum
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*Small, white discrete papules on the face and bridge of nose
--plugged sebaceous glands * Common during the first 2-3 months (p. 17) |
Milia
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* aka "heat rash"
*Caused by occlusion of sweat ducts during periods of heat and high humidity * "prickly heat" (p. 17) |
Miliaria
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*Contact dermatitis
*Medications, supplements *Food sensitivity (p. 17) |
Allergic rash
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*Acid urine output
* Yeast? (p. 17) |
Diaper rash
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*Younger children get it on their face, elbows or knees
* Older children & adults get it on their hands, neck, inner elbows, back of knees, ankles and face (less often). (p. 18) |
Eczematous rash
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* aka "cradle cap"
* Scalp lesions are scaling, adherent, thick, yellow and crusted * Can spread over the ear and down the nape of the neck *Can also be seen on back, intertriginous and diaper areas. (p. 18) |
Seborrheic Dermatitis
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* "Honey colored crusts"
* Highly contagious staph or strep infection * Causes pruritis, burning and regional lymphadenpathy (p. 18) |
Impetigo
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*Tinea corporis
*Tinea capitis (p. 18) |
Ring worm
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What is the most common vector of ring worm? (p. 18)
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pets such as cats and dogs
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*Often not present at birth
* 1-2 months: becomes noticeable * 1-6 months: grows most rapidly * 12-18 months: begins to shrink (p. 18) |
Strawberry hemangioma
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* May be related to:
-- Excessive emotional stress - Family circumstances, hospitalization -- Obsessive Compulsive Disorder (p. 18) |
Trichotillomania
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*Tuft of hair overlying the spinal column usually in the lumbosacral area
* Associated with spina bifida occulta (p. 19) |
Faun tail nevus
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* Evenly pigmented patches
--light, dark brown, or black in dark skin * Present at birth or shortly thereafter * Suspect this if you note >5 patches with diameters >1 cm in a child under 5 *May be related to: - Neurofibromatosis - Pulmonary stenosis - Temporal lobe dysrhythmia - Tuberous sclerosis (p. 19) |
Cafe au lait spots
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*May occur in conjunction with cafe au lait spots
* Associated with neurofibromatosis (p. 19) |
Axillary freckling or inguinal freckling
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* When it involves the opthalmic division of the trigeminal nerve it may be associated with:
-- Sturge-Weber syndrome -- Occular defects (p. 19) |
Facial port-wine stain
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Associated with renal abnormalities (p. 19)
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Supernumerary nipples
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How should you exam a newborn for Hyperbilirubinemia? (p. 20)
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* Examine the oral mucosa and sclera
* Inspect the whole body for "dermal icterus" - starts on the face and descends - Bilirubin level is not high if only the face (5mg/dl) - May be at a worrisome level if jaundice descends below the nipples ( >12 mg/dl) |
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What are the risk factors for Hyperbilirubinemia? (p. 20)
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* Breast feeding
-- b-glucuronidase * Cephalhematoma or other cutaneous or subcutaneous bleeds * Hemolytic disease * Infection |
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*present in 50% of newborns
-- appears to be an inability of the liver to conjugate bilirubin present in the blood * Starts after the first day of life -- Usually disappears in 8-10 days -- May persist for 3-4 weeks Treat with bili lamp or bili blanket (p. 20) |
Physiologic Jaundice
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* Jaundice that is present in the first 24 hours, or is intense or persisent
Possible causes include: - RBC abnormalities - Hemorrhage - Impaired hepatic function - TORCHES infections -- Toxoplasmosis -- Rubella -- Cytomegalovirus -- HErpes --Syphilis (p. 20) |
Pathological Jaundice
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When inspecting the skin, if you see assymetrical creases on the thighs, what might that indicate? (p. 20)
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Possible hip dysplasia
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When inspecting the skin, if you see a Simian Line on the hands and feet, what might that indicate? (p. 20)
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Possible Down Syndrome
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What is the Schamroth Technique? (p. 20)
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* Place nail surfaces of corresponding fingers together
-- Normal: Diamond shaped window -- Clubbed: angle between distal tips increases |
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What conditions are clubbing of the nails associated with? (p. 21)
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* Respiratory disease
* Cardiovascular disease * Thyroid disease * Cirrhosis * Colitis |
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How is skin turgor best evaluated? What could "Tenting" of the skin indicate? (p. 21)
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* Best evaluated by gently pinching a fold of the abdominal skin
*Tenting indicates dehydration or malnutrition |
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* Periodic cessation of breathing during sleep due to airflow obstruction
* Can be seen in children with excessively large tonsils (p. 21) |
Obstructive Sleep Apnea
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* May occur at any age (most common in teens)
* Initial symptoms: -- Pharyngitis, fever, fatigue, malaise * Exam findings: -- Enlarged anterior and posterior cervical chains -- Splenomegaly, hepatomegaly, and/or a rash may be noted (p. 22) |
Infectious Mononucleosis
-- Epstein-Barr virus |
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* Symptoms
-- Sore throat and runny nose -- Headache, fatigue & abdominal pain * Exam findings: -- Palatal petichiae -- Enlarged anterior cervical nodes |
Strep Pharyngitis
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Unusual contour of the cranial bones may be related to what? (p. 23)
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* Irregular closing of suture lines (craniosynostosis)
* Positional head deformity (PHD) * Preterm infants: soft cranial bones flatten with the positioning and weight of the head |
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At what age does the posterior fontanel close? The anterior? (p. 24)
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posterior fontanel closes at approximately 2 months
anterior fontanel closes by 24 months |
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When performing transillumination on an infant, a ring of <2 cm is expected on all regions of the head except the occiput (should be <1 cm). Illumination beyond these parameters suggests...? (p. 24)
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* Excess fluid
* Decreased brain tissue in the skull -- Transillumination should be done on every infant and or an older child if there is a suspected intracranial lesion or rapidly increasing head circumference |
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* If a birth injury, may be due to hematoma
* In older children can be the result of a trauma, muscle spasm, viral infection or drug ingestion. (p. 25) |
Torticollis ("Wry neck")
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What are the differences between positional head deformity and craniosynostosis? (p. 25)
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* Positional head deformity: No ridging, ear on flat side migrates forward, forehead protrudes (same side as occipital flattening), bald spot on side of flattening
* Craniosynostosis: Palpable ridge, ears even or ear on flat side appears to be more posterior, forehead does not protrude, no bald spot or central bald spot |
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*Premature union of cranial sutures
- small head circumference (microcephaly) - Rigid sutures - Misshapen skull - Usually NOT accompanied by mental retardation (p. 26) |
Craniosynostosis
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What is microcephaly related to? (p. 26)
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* Craniostenosis
* Cerebral dysgenesis -- Associated with mental retardation and failure of brain to develop normally |
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* Enlarged head
* Bossing of the skull * Widening of sutures and fontanels * Lethargy, irritability, weakness * Sclera visible above the iris -- "Sunsetting sign" (p. 26) |
Hydrocephalus
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* Softening of the skull
* Demonstrated by pressing the bone along the suture line...bone pops in and out * Associated with: -Rickets and hydrocephalus - Can be a normal finding in up to 1/3 of all newborn infants. More common in premature infants |
Craniotabes
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Asymmetry of facial features
* Eyelid will not close completely * Drooping corner of mouth * Loss of labonasial fold (p. 26) |
Bell's palsy (facial palsy)
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What features are associated with Down Syndrome? (p. 27)
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* Depressed nasal bridge
* Epicanthal folds * Mongolian slant of eyes * Low set ears * Large tongue |
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What features are associated with fetal alcohol syndrome (FAS)? (p. 27)
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* Smooth philtrum
* Widespread eyes --inner epicanthal folds -- Mild ptosis * Hirsute forhead * Short nose * Thin upper lip |
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What development of the eyes should occur during the first year? (p. 27)
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By 2-3 months - voluntary control of eye muscles
By 8 months - can differentiate colors By 9 months - Eye muscles coordinate; a single image is perceived |
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Widely spaced eyes (p. 27)
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Hypertelorism
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"Keyhole pupil" (p. 28)
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Coloboma
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White specks in a linear pattern around the circumference of the iris
-- Suggests Down Syndrome (p. 28) |
Brushfield spots
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aka of Corneal Light Reflex (p. 28)
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Hirschberg's test
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What is normal and abnormal in the cross-cover test? (p. 29)
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* Normal: No movement
* Exotropic eye: Moves lateral to medial * Esotropic eye: Moves medial to lateral |
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What is normal and abnormal in the cover-uncover test? (p. 29)
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Normal: No movement (remains fixed on the light)
Exotropic eye: moves lateral Esotropic eye: moves medial |
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Impairment of extraocular muscles or their nerve supply (p. 29)
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Paralytic Strabismus
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* No primary eye muscle weakness
* can focus with either eye but not both simultaneously...concern of developing amblyopia (p. 29) |
Nonparalytic Strabismus
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When testing visual acuity in a child using a Snellen eye chart, a 2 line difference in the scores between the eyes (i.e. 20/50 and 20/30) may indicate ___________. (p. 30)
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amblyopia ("lazy eye")
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By what age is it anticipated that a child should have 20/20 vision? (p. 30)
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Age 6
Age 3 - 20/50 Age 4 - 20/40 Age 5 - 20/30 Age 6 - 20/20 |
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* A congenital malignant tumor that is common in children less than 2 years old
* Gives a white reflex instead of a red reflex on fundoscopic exam, and there is an ill-defined mass arising from the retina with chalky-white areas of calcification. (p. 31) |
Retinoblastoma
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Low or poorly shaped ears are associated with __________ and congenital anomalies. (p. 33)
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renal disorders
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What must you consider if you see a red reflex in the ear of a child on otoscopic exam? (p. 34)
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If the child is crying or has recently cried vigorously, dilation of blood vessels in the tympanic membrane can cause redness. You cannot assume that redness of the membrane alone is a middle ear infection.
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How does pneumatic otoscopy help you differentiate conditions? (p. 34)
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In a crying red-reflex, the red tympanic membrane is moveable
In an infection, the red tympanic membrane has no mobility |
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What is a classic sign of sinus problems in a child? (p. 36)
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Bad breath due to post-nasal drip
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What might a greyish membrane in the nose indicate? (p. 37)
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Chronic allergies
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Congenital nasal obstruction of the posterior nares. (p. 37)
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Choanal Atresia
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How many deciduous teeth do children get? (p. 38)
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20 deciduous teeth
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What is an abnormally large tongue (macroglossia) associated with? (p. 38)
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Congenital hypothyroidism, congenital abnormalities, Down syndrome
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*Appear along the buccal margins of the gums
*Pearl-like retention cysts *Disappear in 1-2 months (not dangerous) (p. 38) |
Epstein Pearls
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Unconscious grinding of the teeth (check for occiput subluxation). (p. 38)
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Bruxism
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At what age are the tonsils the largest they will ever be? (p. 39)
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age 6
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* Infection of the tissue between the tonsil and pharynx
* Complication of tonsillitis (p. 39) |
Peritonsillar abscess
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Suspected with sudden high fever, drooling, croupy cough, sore throat, apprehension & focus on breathing.
Child adopts a tripod position (juts chin forward, neck extended) Treat as a medical emergency (p. 40) |
Epiglottitis
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What does APGAR stand for? (p. 41)
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Activity
Pulse Grimace Appearance Respirations |
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If the "roundness" of a child's chest persists past the 2nd year, what should you suspect? (p. 42)
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Chronic obstructive pulmonary problem
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If you kiss a baby and it tastes salty, what should you suspect? (p. 42)
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Autosomal recessive disorder of exocrine glands - Cystic Fibrosis
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What can a relatively larger chest circumference indicate? (p. 42)
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Poorly controlled diabetes
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What is discharge from an infant's nipples known as? (p. 42)
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Witch's milk
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What is an average respiratory rate for an infant? (p. 43)
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40-60 rpm (80 rpm is not uncommon)
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What is the most common fracture at birth? (p. 43)
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clavicle
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Floppiness of the trachea causing wheezing, inspiratory stridor. (p. 45)
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Laryngomalacia
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Viral ( respiratory syncytial virus - RSV), most common <6 months
Expiration becomes difficult due to hyperinflation of lungs. (p. 45) |
Bronchiolotis
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What is the most common sign of asthma in kids? (p. 47)
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Coughing
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* Viral cause, most often parainfluenza viruses
* Very young children ( 1 1/2 to 3 years) * Boys > girls (p. 47) |
Croup
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What does severe cyanosis evident at birth or shortly after suggest? (p. 49)
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* Transposition of the great vessels
* Tetralogy of Fallot * Tricuspid atresia * Severe septal defect * Severe pulmonic stenosis |
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What are the "S" items associated with innocent murmurs? (p. 50)
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Short
Soft Systolic Unaccompanied by other Sounds & Symptoms |
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Narrowing in a portion of the aorta
(can cause severe life-threatening complications) (p. 52) |
Coarctation of the Aorta
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