Thomson 4-16-08 Physical Examination Of The Pediatric

Front 1

general goals of the newborn exam

Back 1

identify major and minor congenital anomalies
sequelae of birth trauma
neonatal medical problems
determine gestational age
appropriateness of size for gestational age

Front 2

What do you notice about newborns's general appearance

Back 2

activity
quality of cry
skin color
gross abnormalities
unusual features
signs of respiratory distress

Front 3

normal peripheral vascular instability include: skin mottling, perioral cyanosis, and cyanosis of the hands and feet (acrocyanosis), with the lips, mucous membranes, nailbeds remaining ____.

Back 3

normal peripheral vascular instability include: skin mottling, perioral cyanosis, and cyanosis of the hands and feet (acrocyanosis), with the lips, mucous membranes, nailbeds remaining pink.

Front 4

Lanugo?

Back 4

light covering of hair on babies that does away

Front 5

Things to notice about newborn's skin

Back 5

Cracking or Desquamation
Jaundice
Lanugo
salmon patch nevus (not important)
mongolian spot (

Front 6

Mongolian Spot

Back 6

a benign flat congenital birthmark with wavy borders and irregular shape, most common among East Asians and Turks, and named after Mongolians
disappears three to five years after birth and almost always by puberty

Front 7

Benign rashes are common:

Erythema _______ neonatorum has a “flea-bite” appearance.
_____ : fine, pinpoint, yellow-white papules that cover the bridge of the nose, chin and cheeks
Neonatal pustular melanosis

Back 7

Benign rashes are common:

Erythema toxicum neonatorum has a “flea-bite” appearance.
Milia : fine, pinpoint, yellow-white papules that cover the bridge of the nose, chin and cheeks
Neonatal pustular melanosis

Front 8

an elongated or asymmetric contour of the head

Back 8

Molding

Front 9

subperiosteal hemorrhage results in unilateral swelling

Back 9

Cephalhematoma

Front 10

edema of the scalp due to the pressure of delivery

Back 10

Caput succedaneum

Front 11

Newborn eyes:

Normal to appear “crossed” < three months of age, however, a “_____” misalignment is always abnormal

Back 11

Newborn eyes:

Normal to appear “crossed” < three months of age, however, a “fixed” misalignment is always abnormal

Front 12

congenital defect characterized by incomplete development of the ear, nose, soft palate, lip, and mandible. It is associated with anomalous development of the first branchial arch and second branchial arch.

Back 12

Goldenhar syndrome (also known as Oculo-Auriculo-Vertebral/OAV syndrome)

Front 13

Things to notice about newborn ears

Back 13

Patency of the canals
Malformed ears
Low set ears

Front 14

Newborns are obligate ____ breathers. Obstruction of the nasal passages may result in respiratory distress
________ atresia : unilateral or bilateral, may be life threatening, an inability to pass a catheter easily should raise the suspicion.
Septal hematoma

Back 14

Newborns are obligate nose breathers. Obstruction of the nasal passages may result in respiratory distress
Choanal atresia : unilateral or bilateral, may be life threatening, an inability to pass a catheter easily should raise the suspicion.
Septal hematoma

Front 15

Things to notice about a newborn mouth

Back 15

Examine by inspection and palpation.
Evaluate:
suck
soft palate
uvula

Front 16

Things to notice about a newborn neck

Back 16

Hyperextend the neck to exam adequately for masses.
Webbing of the neck
Congenital masses:
-goiter
-branchial cleft cysts
-thyroglossal duct cysts

Front 17

Things to notice about a newborn chest

Back 17

Clavicles: palpated for the signs of fracture, including crepitance and irregularities
Chest symmetry
Breath sounds
Evidence of respiratory distress
grunting, flaring or retraction

(retraction of abdomen with attempted inspiration with obstruction - try it!)

Front 18

Things to notice about a newborn heart

Back 18

Observe chest wall movement
Palpate Point of Maximum Intensity (PMI)
Auscultate heart sounds
Palpate pulses (including brachial and femoral)
Blood pressure

Front 19

Things to notice about a newborn abdomen

Back 19

Convex in shape and moves prominently with respiration
Umbilicus: 2 arteries and 1 vein
Palpate the liver edge: 1-2cm below the right costal margin
Palpate the kidneys
Palpate for abdominal masses

Front 20

Things to notice about a newborn inguinal region and genitalia

Back 20

Femoral pulses
Rectal exam: patency
Male genitalia:
-urethral meatus
-palpate testes
-bulge in the groin or scrotum
Female genitalia:
-urethra
-vaginal opening
-transient swelling of labia majora
-vaginal discharge: mucoid or bloody
-skin tag

Front 21

Name some Developmental Dysplasia of the Hip

Back 21

congenital hip dislocation, subluxation and acetabullar dysplasia

Front 22

____________ position of the infant has a direct correlation to the development of Developmental Dysplasia of the Hip

Back 22

Intrauterine position of the infant has a direct correlation to the development of Developmental Dysplasia of the Hip

Front 23

_____% of children with DDH are delivered with breech presentation
All breech presentation babies should be fully evaluated for DDH

Back 23

30-50% of children with DDH are delivered with breech presentation
All breech presentation babies should be fully evaluated for DDH

Front 24

In most instances, newborns with dislocatable have what anatomical problems

Back 24

otherwise-normal anatomy except for loose or stretched ligaments.

Front 25

DDH is more common in which pts?

Back 25

female (8x)

Front 26

__% of the DDH cases are more severe and long-standing with resultant in utero deformity of the femoral head and acetabulum.

Back 26

20% of the DDH cases are more severe and long-standing with resultant in utero deformity of the femoral head and acetabulum.

Front 27

Which hip is more commonly involved in DDH?

Back 27

The left hip is 4 times more likely to be involved

25% bilateral involvement

Front 28

When do you dx DDH? How do you do it? What age?

Back 28

Diagnosis is primarily made by physical examination
Must be found when examining well children from birth to six months of age
Ultrasound of the hip useful modality at birth
X-ray of the hip remains the “Gold Standard” at 4 months of age

Front 29

Describe Ortoloni Maneuver

Back 29

Infant lies supine on a firm surface
A reduction maneuver (Ortoloni) is preformed by grasping the lower limb with the fingers extended over the greater trochanter and simultaneously lifting and abducting.
If dislocation is present, a palpable “clunk” occurs as the head of the femur pops back into the acetabulum

Front 30

Describe Barlow Maneuver

Back 30

This is the reverse maneuver or dislocation test
Performed by grasping the leg in the same manner as the Ortoloni but press down and simultaneously adduct
If the femur pops out it will be felt and can be confirmed by the Ortoloni

Front 31

Small degrees of crepitance or slight sensations of clicking are usually due to WHAT?

Back 31

Small degrees of crepitance or slight sensations of clicking are usually due to ligaments, cartilage or other soft tissue structures