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Pediatrics. G.examination - Leaderboard
Pediatrics. G.examination - Details
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160 questions
| 🇬🇧 | 🇬🇧 |
| What does it mean gross motor development, fine motor development-give the examples | Gross motor - fine motor |
| What are the parts of physical examination? | General state physical development psychomotor development skin lympnodes muscles bones and joints head neck chest abdomen urogenital organs neurological examination |
| What measurements have to be taken to asses general state? | Vital signs -HR -BP -breathing rate -temp |
| Demonstrate, how we examine general state. Comment it , assuming that a patient is healthy | General impression CNS condition (level of consciousness, alert and oriented) Respiratory condition (respiratory rate, NO dyspnea) Cardiovascular condition (HR, BP, NO tachycardia or bradycardia, NO cyanosis, edemas) Vital signs (HR,BP,breathing rate, temp) General state good VIDEO! |
| How do we divide the physical examination? | General (general state, physical development, psychomotor development, skin, lymphnodes, muscles, bones and joints) Detailed (head, neck, chest, abdomen, urogenital organs, neurological examination) |
| What systems have to be sufficient to say that patient is in good general state? | CNS Respiration Cardiovascular |
| Imagine you have found lymph node on the neck of you patient. Describe it | Size Consistence: soft, tough, cohesive, splashing Tenderness, pain Fixed or movable Skin over lymph nodes- normal, reddish, hot, ulcerous Location |
| Describe examination of normal skin ( no abnormalities) | Turgor Color (pink-normal, cyanosis, jaundice, paleness) Dry? Skin lesions Primary morphology (macule, papule, plaque, vesicle, Petechiae, etrc.) Secondary morphology (crust, scar, , erosion, et,) Temperature Hair, nails |
| What are the parameters of physical development assessed during examination? | Height/length weight head circumference chest circumference body proportions |
| What are the elements of psychomotor development? Explain | Gross motor Fine motor Speech Social skills |
| What is gross motor- what are the milestones ? | Posture and locomotion lifting head in prone position (3mo) • turns from the prone to supine position (6mo) and inversely (7mo) • sitting while seated (6-7mo) • sitting up (8mo) • standing up (10mo) • walking with suport (10-11mo), on one’s own (12mo) |
| What is fine motor- what are the milestones | Visual-motor coordination Newborn: uncoordinated movements, infantile reflexes • 3 mo: fixing sight, following an object, own hands • 5 mo: grasping (ape-like grasp), rattling, manipulating with objects • 7 mo: scissor-like grasp, handling few objects, transferring from one hand to the other, anticipating where to fall when thrown 9 mo: pincer-like grasp, dynamic developement of manual skills 10-11 mo: can ‚draw’, build with blocks, tries to eat on one’s own |
| Describe physical development of 6 mths , 6 years child, use the charts | Height/length weight head circumference (equal with the chest at 6 month) chest circumference body proportions |
| Describe psychomotor development od 6 mths infant, 10 mths infant | 6 month -gross motor (turns from prone to supine position, sitting while seated) -fine motor (ape like grasp, manipulating objects) -speech (cooing) -social skills (distinguishes between familiar persons and strengers, recognizes mother ) 10 month -gross motor (standing up, starts walking with support) -fine motor (can draw, built blocks and eat on its oun) -speech (echolalia, speech understanding) -social skills (imitates other at play, gives toys) |
| What is the average head and chest circumference in full term new born, when do these circumferences become equal? | Head 2cm larger at birth than chest (34cm 32 cm) equalls at 6 month |
| What are the methods of physical examination? | Inspection palpation percussion auscultation |
| What skin lesions can be found while examination ? | Skin lesions -Primary morphology (macule, papule, plaque, vesicle, Petechiae, etrc.) -Secondary morphology (crust, scar, , erosion, et) Abnormalities: -pale, - grey, -cyanotic, -reddened, -yellow: jaudice ( orange shade in unconjugated hiperbilirubinemia, olive- in cholestatic jaudice -caroten pigmentation( absence of yellow colour on sclera ), -brown in adrenal dysfunction -mottled skin |
| Posture failure- give the examples, explain | Scoliosis kyphosis lordosis |
| What does it mean gross motor development, fine motor development-give the examples | Gross motor - posture and locomotion (walking) fine motor -visual motor coordination (eating) |
| 6 month infant girl weighs 7 kg, her length is 65 cm, head circumference is 40 cm chest circumference is 40 cm- assess physical development of this child | The chest to head circumference ratio is appropiate to age her weight is appropiate to age her length is appropiate to age |
| What is dyspnoea, what kinds od dyspnoea can be distinguished ? | Dificulty in breathing Inspiratory - mild Expiratory - moderate Mixed - severe |
| What is proper heart rate/respiratory for neonate, infant, preschool child, school child? | Neonate 100-180 infant 110-160 preschool 90-140 school child 5-12yr 80-120 school child >12yr 60-100 60 neonate 30-40 preschool 15-20 above 12 |
| General condition parts | Consciousness Cardiovascular system Respiratory system General appearance |
| How do we grade state of awareness? | Look picture |
| Quantitative disturbances of consciousness | Awake verbal pain unresponsive |
| Pediatric glasgow coma scale | See picture |
| Quantitative disturbances of consciousness | - Infection (encephalitis, meningitis) - Head damagePoisoning (drugs, psychoactive substances, etc.) - Bleeding into the CNS (premature babies !!) - Expansive process (tumor) |
| Differentiation, diagnostics for quantitative disturbances of consoiusness | 1.history, accompanying symptoms (vomiting, nausea, pain, neurological symptoms (nerve palsy, etc.) 2. Additional testing: - examination of the cerebrospinal fluid (CSF) - imaging tests (ultrasound, CT) - toxicological and biochemical tests (blood, urine) |
| Dyspnoea is judged by? | Increased work of breathing is judged by: • nasal flaring • expiratory grunting – to increase positive endexpiratory pressure • use of accessory muscles, especially sternomastoids • retraction (recession) of the chest wall, from use of suprasternal, intercostal and subcostal muscles • difficulty speaking (or feeding). |
| Type of dyspnea | Inspiratory, expiratory, mixed |
| Dyspnoea causes... | Central (damage to the CNS (toxic, bleeding, etc.), cardiogenic, hematological, etc. |
| What can be the cause of dyspnoea? | Infection (upper, lower respiratory tract) • Foreign body in the respiratory tract • Chemical burn • Vascular ring • Tracheo-esophageal fistula |
| Differentiation diagnostics of dyspnoea | 1. Interview, accompanying symptoms (fever, anorexia, cough, cyanosis, vomiting) 2. Physical examination !! 3. Additional research - imaging (lung ultrasound, chest X-ray, contrast tests, -laryngo- endoscopy, esophago-) - laboratory (parameters of inflammation, antigens, anti-bodies) - functional (functional) |
| Causes of cough | - Infection (upper, lower respiratory tract) - Foreign body in the respiratory tract - Vascular ring - Tracheo-esophageal fistula - Allergy - Bronchial asthma |
| Differentiation diagnostics of cough | 1.history, accompanying symptoms (fever, anorexia, cyanosis, vomiting, rhinitis, skin changes) 2. Physical examination !! 3. Additional research - pictorial - laboratory - functional - allergic |
| What is syncope? | Temporary loss of consciousness due to a decrease in brain perfusion (interruption of cerebral flow for 6-8 seconds or a reduction of oxygen delivered to the brain by 20%). Syncope is rapid onset, usually resolving spontaneously and quickly (<20 s) |
| Causes of syncope | - Situational - Neurocardiogenic - Heart arythmia - Shock, - Hypovolemia - Anemia - Heart defect (e.g. aortic coarctation) - Stress - Migraine - Poisoning |
| What is the difference between true and pseudo cyanosis? | True - increased concentration of deoxygenated hemoglobin in the blood capillary (> 5 g / dL) or presence of pathological hemoglobin (most often methemoglobin> 0.5 g / dl) pseudo - abnormal pigment in the skin (drugs - chlorpromazine, amiodarone, minocycline; heavy metals - silver, gold |
| What is the difference between peripheral and central cyanosis? | Peripheral cyanosis (blueness of the hands and feet) may occur when a child is cold or unwell from any cause or with polycythaemia • Central cyanosis, seen on the tongue as a slate blue colour, is associated with a fall in arterial blood oxygen tension. It can only be recognised clinically if the concentration of reduced haemoglobin in the blood exceeds 5 g/dl, so it is less pronounced if the child is anaemic |
| Fever differentiation and diagnostics | Differentiation • Infectious diseases (urinary, respiratory, nervous, digestive) • Autoinflammatory diseases ((fever of unknown origin (FUO), recurrent fever syndrome, juvenile idiopathic cellulitis, Kawasaki disease • Diseases of the CNS (encephalopathy) Diagnostics • Interview!! • Physical examination !! • Additional tests - depending on the most probable cause |
| Pain rating | Visual scale Verbal (descriptive), Numeric (0-10) |
| Pain, diagnostic and differentiation | Diagnostics and differentiation - location, radiation, character (piercing, etc.) - accompanying symptoms - Chronic diseases any injuries, burn acute pancreatitis biliary colic, appendicitis renal colic neuralgia (including the most common trigeminal neuralgia) migraine traumatic Interview Examination of the subject (elements of the neurological examination !!) |
| Primary vs secondary headache vs cranial neuralgias | Primary headaches: four main groups, comprising migraine, tensiontype headache, cluster headache (and other trigeminal autonomic cephalalgias); and other primary headaches (such as cough or exertional headache). • Secondary headaches: symptomatic of some underlying pathology, e.g. from raised intracranial pressure and space-occupying lesions • Trigeminal and other cranial neuralgias, and other headaches including root pain from herpes zoster. |
| What is a seizure? | A seizure is a clinical event in which there is a sudden disturbance of neurological function caused by an abnormal or excessive neuronal discharge. Seizures may be epileptic or nonepileptic. |
| Epileptic vs non epilepleptic seizures | Epileptic -idiopathic in 80% of cases -secondary (cerebral dysgenesis, cerebral vascular occlusion, cerebral damage) -cerebral tumor neurodegenerative dissorder -neurocutaneous syndromes non-epileptic - febrile seizures - metabolic (hypoglyceamia, hypomagnesemia, hypo/hypernatremia) - head trauma - meningitis - encephalitis - poison or toxin |
| Febrile seizures | - 3% of children (genetic predisposition) - between 6m and 6y - brief, tonic-clonic -rapid rise in fever! |
| What in medical history do we need to consider when it comes to respiratory system and cardiovascular? | Respiratory system: Cough Dyspnoe Pain in chest Apnoe Hematoptysis Cyanosis Cardiovascular system: Dyspnoe Oedemas Cyanosis |
| What do we need to consider during physical examination when it comes to respiratory and cardiovascular system? | Respiratory system: Tachypnoe/bradypnoe Dyspnoe Cyanosis Patologic sounds upon auscultation Abnormalities on auscultation Cardiovascular system: Tachycardia /bradycardiaMurmurs Arrhytmias Abnormal apex beat |
| What is cough? | Cough- sudden expulsion of air -protective reflexphysiologically removing particles from airway , incidental cough- normal phenomenon • Recurent coughing- sign of disease • Most frequently manifestation of upper or lower respiratory airways |
| What 3 types of cough do we have? | Dry cough- usually upper respiratory tract infections • Productive cough-usually lower respiratory tract infection( bronchitis, pneumonia) • Acute caugh( <3 weeks, usually infections), persistent( 3- 8 weeks), chronic ( >8weeks) |
| Causes of acute cough | • Infections • Asthma • Choking • Forein body in airways • Pneumothorax |
| Causes of chronic cough | • Cystic fibrosis • Gastro-esophageal reflux • Tuberculosis • Bronchiectases( CF, immune deficiencies) • Impression on airways( tumor-lymphoma, vascular ring) • Foreign body in Airways • Reccurent aspiration due to oesophago-tracheal fistula• Chronic interstitial lung diseases • Chronic sinusitis |
| Signs of dyspnoea: | -use of accessory respiratory muscles, -nasal flaring, -grunting, -subcostal retraction - excessive movements of diaphragm Abnormal respiratory rate( bradypnoe, tachypnoe) may accompany dyspnoea |
| Most frequent causes of dyspnoe- respiratory system diseases | Respiratory dyspnoea • Inspiratory: upper airway( throat,larynx, trachea) • Expiratory : lower airway- bronchi • Mixed dyspnoea: alveoli |
| Types of dyspnoea | Respiratory dyspnea – due to respiratory tract pathology, • Cardiac dyspnea – cardiac failure • Metabolic dyspnea – usually due to acidosis • Anaemic dyspnea – due to dysfunction or low number of red blood cells • Neurognic dyspnea – secondary to neurologic system impairmen • Inspiratory dyspnea – laryngitis, larynospasm, laryngeal oedema ( anaphylaxis), foreign body in larynx • Expiratory dyspnea- asthma, wheezy bronchitis, bronchiolitis • Mixed dyspnea- pneumonia, pleuritis, pneumothorax |
| Pain in chest, what is it and what causes it? | Contrary to adults, children most often suffer from non-cardiac causes of chest pain (e.g. a heart attack practically does not occur in children). Causes • Pleuritis • Emphysema • Pulmonary embolism • Myocarditis • Pericarditis • Acute pancreatitis • Psychogenic causes (after exclusion of organic causes !!!) |
| Apnoe, what is it and what causes it? | Blockage of airflow in respiratory tract Causes • Hypertrophy of tonsils • Decreased muscle tone • Obesity • May appear also in healthy individuals Affective apnea- preceded by strong emotions |
| What types of apnoe do we have? | • Central- immaturity of medullar respiratory centre, decreased sensitivity to hypercapnia, mainly in premature infants • Obstructive- obstruction of upper respiratory airways, non-efectiverespiratory movements, obstructive sleep apnoea is an indication for laryngologic consutation |
| Hemoptysis | Rare symptom in children Mostly originate from throat/nose • Nasophrygeal infection • tonsilitis From lower respiratory tract • bronchiectases ( cystic fibrosis, immune deficiencies) • pulmonary abscess • tuberculosis • vasculitis |
| What is cyanosis and what types do we have? | Definition- bluish discoloration, especially of the skin and mucous membranes, due to excessive concentration of deoxygenated hemoglobin in capilary blood -> 5 g/dl Cyanosis classification • Central- decreased saturation of oxegen saturation of hemoglobin in arterial blood, predominantly visible on lips, tongue and oral cavity. • Peripheral- decreased perfusion of periphery, visible on peripheral parts of body |
| What dieses can cyanosis be a symptom of in respiratory and cardiovascular systems? | Diseases of respiratory tract( respiratory failure) • Foreign body of trachea, larynx • Choanal atresia • Epiglottitis • Bronchiolitis • Severe asthma attack • End stage of cystic fibrosis Diseases of cardiovascular system • Cyanotic cardiac defect (ie. Falot syndrome) • Cardiogenic shock • In all the mentioned condiotions exept cardiogenic shock central cyanosis |
| Tachypnoe/bradypnoe | • Abnormal( too high/too law respiratory ratein relations to age Normal respiratory rate • newborn 40-60/min • infant 30-50/min • 1-5 years 26-40/min • 6-8 years 18-30/min • older 14-20/min • Most frequently accompanies dyspnoe |
| Auscultation abnormalities over lungs- pathologic sounds | Rhonci and wheezes- come from bronchi as a result of their obturation due to oedema and mucus overproduction, usually present on expiration Crepitations, crackles – audible when air comes back into atelectatic vessicles (atelectasis, inflammation) best heard at the top of inspiration, typical for pneumonia Pleural friction- best heard at the end of inspiration and the beginning of expiration in pleuritis without exudate. |
| Auscultation abnormalities over lungs- pathologic sounds 2 | Patologic bronchial sound if present over lungs, not in the typical location- lobar pneumonia • Prolonged expiration- obstruction of bronchi , wheezy bronchitis, bronchiolitis • Prolonged inspiration – narrowing of larynx, laryngitis |
| Percussion abnormalities | • Dull pecussion sound –presence of fluid in pleura ( pleuritis) airless fragment of lung( atelectasis), diffuse pneumonia ( loban pneumonia) • Hyperresonant sound – emphysema • Tympanic sound - pneumothorax |
| Vocal fremitus abnormalities | Absent or decreased- pnaumothorax, presence of fluid in pleural cavity Increased- over an airless part of lung- lobar pneumonia |
| Tachycardia | • Heart rate above the normal range in relation to age. May be physiologically present. In many pathologies. Compensative mechanism • 1 month – 100-180 • 2-6 month – 100-140 •6-12 month – 100-120 •2-6 years – 90-110 •7-10 years – 80-100 •11-14 years – 70-90 |
| What types of tachycardia do we have? | Sinusal • fever, stress, anxiety • hipotension • anaemia • conditions presenting with hypoxia, respiratory failure • severe infections • hyperthyroidism, • cardiac failure, medications/stimulants • dehydration, shock Extra sinusal- cardiologic diseases |
| Bradycardia | • Bradycardia- heart rate lower than norm in relation to age The most common causes • Apnoe and bradycardia of premature infants • Arrhytmias and conduction disturbances • Increased intracranial pressure • Medications |
| Arrhythmia | Respiratory arrhythmia- physiologic in children, increasedheart rate on inspiration, dissapaers , when a child stops to breathe Arhythmias- cardiologic diseases |
| How do we divide cardiac murmurs? | Cardiac ( systolic, diastolic, systo-diastolic ) • Organic causes - cardiac defects • Functional – cardiac enlargment, hyperkinetic circulation • Innocent murmurs Extracardiac (pericardial friction) |
| Characteristics of innocent murmurs | • Loudness 1-3/6 Levine’s scale • Without any heart failure. • Proper development • Mainly systolic • Position dependent |
| Apex beat abnormalities | Diffuse,high, abnormally located: cardiac defects, cardiac failure,cardiomyopathies |
| Skin colour abnormalites | - Palor • Redness • Icterus • Cyanosis |
| Causes of palor | Anaemia- palor best visible on lips, auricles, conjunctiva • Infections • Dehydration • Low blood pressure- syncope • Shock |
| Causes of redness | Fever • Overheating • Carbon monoxide intoxication • Neonates in first days of life- skin physiologically redpolicytemia • Local redness for example over inflammed lymphnode or joint |
| Causes of icterus | The most common causes !!!! • Physiologic jaundice in 60% !!!! of full term neonates • Breast milk jaundice Blood and liver diseases as causes of jaundice will be discussed next year |
| Patomechanisms of physiologic jaundice | Immaturity of the liver- decreased conjugation with glucuronic acid • Increased destruction of erythrocytes( presence of fetal hemoglobin,) • Increased enterohepatic circulation of bilirubin |
| Criteria of physiologic jaundice | • Unconjugated bilirubin • Not in the first day of life • Not longer than 10 days ( ful term newborns),14 days premature neonates • Level lower than 15 mg% (artificial feeding) i 17 mg% ( brest feeding) • The daily increase lower than 5 mg% , less than 0,3 mg% per hour • No pathologic symptoms present |
| Breast milk jaundice | Components of breast milk hinder bilirubin conjugation • early ( 2-3 day) late(7 day) • unconjugated bilirubin • therapeutic-diagnostic trial- the decrease in bilirubin level after stopping breast feeding for 24-48 h or feedingwith previusly heated breast milk • needs to be differentiated with pathologic jaundices |
| Oedema patomechanism | • Decreased oncotic pressure : (hypoalbuminemia) • Increase blood vessels permeability • Venous stasis • Lymph stasis |
| Main causes of oedemas | Cardiac failure • Renal failure • Liver failure • Nephrotic syndrome • Allergy |
| Primary skin lesions | Macule • papule • vesicle • blister • pustule • wheal • nodule |
| Secondary skin leasions | • crust • erosion • scale • lichenication • scar • excoriation |
| Macule | Most common category erythematous due to blood vessels dilatation upon pressing dissapear if its macular rash upon pressing do not dissapear if its hemorrhagic rash - fever and measles - allergic rash allergy to drugs - in Schoenlein Henoch disease - hemorrhagic rash in meningococcal sepsis - cafe au lait |
| Papule | - diper dermititis |
| Vesicle | Chickenpox (vesicular rash) wheal |
| Pustule | Acne |
| Lichenication | Atopic dermatitis |
| Excoriations | Atopic dermititis |
| Scale | Seborrhoic dermatitis |
| During the examination of lymph nodes the following elements have to be assessed | Size location number single/cluster consistency- hard, soft, firm mobile/fixed Tenderness appearence of the skin over lymphnode: normal/inflammed |
| The following groups of lymph nodes have to be palpated | • occipital • retroauricular • nuchal • preauricular • cervical • submadibular • axilar • supraclavicular • inguinal |
| Lymphadenopathy, the most important causes | Lymphadenitis- painful lymph nodes • Reactive lymphadenopathy due to infection in the region of lymph node: submandibular lymphadenopathy in tonsilitis or labial heres • General infections( rubella- occipital lymphadenopathy, glandular fever- cervical lymphadenopathy) • Hematologic malignancies: -General lymphadenopathy- lymphoblastic leukemia -Single lymphnode or cluster- lymphoma • Non- infectious disease – Kawasaki disease |
| Nerons neck | Lynphadenopathy in glandular fever caused by Epstein Bar virus (mononucleosis) |
| Hodgkin lymphoma | Lymphadenopathy, cancer |
| Abdominal pain depends on.... | - Type of stimuli • Type of nociceptors • Way of conduction • Patient’s personality • Cultural patterns • Other |
| Etiology of abdominal pain | Diseases of digestive tract • Diseases of other intraabdominal organs (kidney, urinary tract) • Disease of organs, systems located outside the abdomen (pleura, lung) • Systemic diseases (endocrine, metabolic) • Effect of drugs • Effect of toxic substances - organic diseases - functional disorders |
| Acute abdominal pain – surgical | - Acute pain • Vomiting • Abdominal distention • No gases, no stool, bloody stool • Fever • Severe general state • Peritoneal symptoms |
| Acute abdomen causes | Acute appendicitis • Ileus • Intussusception • Volvulus • Incarceretion of hernia • Peritonitis • Perforation • Meckel’s divericulitis • Acute pancreatitis • Trauma |