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What sound is heard when percussing a solid mass such as bone or muscle?
- Flat
- High-pitched, soft-intensity sound
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What soundis heard when percussing a high density structure such as the liver?
- Dull
- Medium-pitched, medium-intensity
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What sound is heard when percussing a hollow organ such as the lungs?
- Resonance
- Low-pitched, loud-intensity sound
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What sound is heard when percussing the lungs in young children?
- Hyperresonance
- Very low, very loud, with a booming quality
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What sound is heard when percussing an air-filled body part such as the stomach or bowel?
- Tympany
- High-pitched, loud-intensity sound
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What part of the hand is used to palpate the lymph nodes, breast, and pulses?
Fingertips are used to palpate the breast, lymph nodes, and pulses.
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What part of the hand is used to assess temperature? vibrations?
- The back of the hand is used to identify temperature
- The palm of the hand is used to identify vibrations
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What are the potential indicators of child abuse?
- Dress: Inappropriate for the weather; ragged or excessively dirty
- Grooming and personal hygiene: Dirty teeth; broken and dirty fingernails; matted and dirty hair
- Posture and movements: Crouching in a corner; slow, concentrated movements
- Body image distortion: Being thin but describing self as fat
- Speech and communication: Answering questions in words of one syllable; looking to others to respond first; seeking approval for answers
- Facial characteristics and expressions: Fearful, anxious, tearful, sad, or angry expressions
- Psychological state: Labile, demanding, bizarre, overly dramatic, or condescending
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What are the newborn vital signs?
- Newborn
- T: 96.8-99 (axillary)
- HR: 120–160
- RR: 30–60
- BP:60-99/30-62
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What are a 4 year old's normal vitals?
- T: 97.5-98.6 (axillary)
- HR: 80–125
- RR: 20–30
- BP: Girls: 91-104/52-66
- BP: Boys: 93-107/50-65
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What are a 10 year old's normal vitals?
- T: 97.5-98.6 (oral)
- HR: 70–110
- RR: 16–22
- BP: Girls: 102-115/60-74
- BP: Boys: 102-115/61-75
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What are a 16 year old's normal vitals
- T: 97.5-98.6 (oral)
- HR: 55–90
- RR: 15–20
- BP: Girls: 111-124/ 66-80
- BP: Boys: 116-130/ 65-80
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Vitiligo
Areas of depigmentation
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Nevi
Areas of increased pigmentation
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Carotenemia
- An orange color of the skin
- Best seen on the soles of the feet and palms of the hands
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Mottling
Discolored areas of the skin
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Bossing
Frontal enlargement of the head
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Snelling E chart
What ages is this chart used for?
- A standardized chart using the letter E in various directions
- Used with preschoolers ages 3 to 6 years to test far vision at 20 feet
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Lea Chart
What ages is this chart used for?
- A chart with four different symbols.
- Used for preschool-age children. Designed for use at 10 feet.
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HOTV Chart
What Ages is this chart used for?
- A standardized chart with the letters H, O, T, and V in graduated sizes.
- Designed for use at 10 feet with children ages 3 to 6 years.
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Jaeger Chart?
What does this test for?
What ages is this chart used for?
- Standardized chart with graduated letters for testing near vision at 12 to 14 inches from the eyes.
- Used with children older than 6 years
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Ishihara Chart
What does it test for?
What age children should this be used for?
- A series of polychromatic cards with a pattern of dots printed against a background of many colored dots.
- Designed to test for color vision between ages 4 and 6 years.
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hirsutism
excessive growth of hair
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Angle at the nail base and the fingertip should be less than 160 degrees
160 degrees
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A capillary refill time of more than 2 seconds may be caused by...
- anemia
- peripheral edema
- vasoconstriction
- decreased cardiac output as a result of hypovolemia, shock, or congestive heart failure
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An enlarged supraclavicular lymph node on the left in young children is called _________ because it may suggest ______________.
- the sentinel node
- Wilms' tumor or other neoplastic disease.
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Sutures are felt as prominent ridges in the neonate but usually flatten by.....
6 months
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The posterior fontanel is closed by....
The anterior fontanel should be closed by...
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Webbing of the neck (the presence of an extra fold of skin posteriorly) is associated with what kind of abnormalities?
chromosomal abnormalities such as trisomy 21 or 18
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Hypertelorism
- A condition in which the eyes are unusually widely spaced
- Therefore, hypotelorism means they are close together
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The eruption of deciduous teeth begins around_____;
all 20 deciduous teeth are present by ____
- the sixth month of extrauterine life;
- 30 months
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Visual accuity testing should begin no later than....
3 years old
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Normal Ranges of visual accuity: Birth? 4 months? 1 year? 4 years? 5 years?
* 20/20: annotation means that the child has correctly interpreted the letters on the chart for 20 feet at a distance of 20 feet
- Birth: fixates on objects (8 to 12 inches), 20/100 to 20/150
- 4 months: 20/50 to 20/80
- 1 year: 20/40 to 20/70
- 4 years: 20/30 to 20/40
- 5 years: 20/20 to 20/30
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What are the three tests to identify binocular visual alignment or the presence of strabismus?
- corneal light reflex (Hirschberg) test
- field-of-vision test
- cover/uncover (alternate cover) test.
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Pectus excavatum is what and may cause what?
- Funnel chest: depression in the sternum
- May cause heart murmurs do to compression of the heart and vessels
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Pectus carinatum is what and
Pigeon chest; sternum is displaced anteriorly and may increase A:P diameter
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Crackles are heard when...
there is fluid in the lungs
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Late inspiratory crackles are heard in which conditions?
occur with restrictive disease: pneumonia, congestive heart failure, and interstitial fibrosis
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Early Inspiratory crackles are heard in which conditions
occur with obstructive disease: chronic bronchitis and asthma.
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A very superficial sound that is coarse and low-pitched
it has a grating quality, as if two pieces of leather were being rubbed together.
sounds just like crackles but close to the ear
It sounds louder if you push the stethoscope harder into the chest wall.
What is it?
Pleural Friction Rub
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High-pitched, musical squeaking sounds that predominate in expiration but may occur in both expiration and inspiration.
Coughing frequently will change the character of the sound.
- High pitched wheeze
- occurs with asthma
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Low-pitched, musical snoring, moaning sounds.
They are heard throughout the cycle, although they are more prominent on expiration
may clear some what by coughing.
- Ronchi
- Heard with bronchitis
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Birth weight doubles by ___ , triples by ____.
Birth length increases by 50% at ___ months.
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Social smile occurs at __ months.
Head turns to locate sounds at ___ months.
Moro reflex disappears around ___ months.
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Plays Peek-a-boo by ___ months.
Steady head control is achieved at __ months.
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Stranger anxiety is developed by ____.
Rolls from abdomen to back and back to abdomen at ___ months.
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Sits unsupported at __ months.
Crawls at ___ months.
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Walks with assistance at ___ months.
Says a few words in addition to “mama” or “dada” at __ months.
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When does birth length double?
by 4 years
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When does a child achieve 50% of adult height?
When does a child throw a ball overhand?
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When does a child speak two- to three-word sentences?
When does a child use scissors?
When does a child tie his or her shoes?
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Daytime toilet training can usually be started around ___.
Own first and last name can be stated by___.
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Each Year, the preschool child (age 3-6) gains ___ lbs and grows ___ inches
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Each Year, the school age child (6-12 yrs) gains ___ lbs and grows ___ inches
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baby sits in a tripod position by...?
7 months?
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baby crawls by?
baby walks alone by
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Cranial Nerve I is assessed by?
- Olfactory
- The child is asked to identify familiar odors with the eyes closed. Each side of the nose is tested separately.
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Cranial Nerve II is assessed by?
Snellen chart, HOTV chart for young children, or the tumbling E chart for very young children. Each eye is tested separately and then both eyes together. If corrective lenses are worn, the eyes are tested both with and without correction.
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Crainial Nerve III, IV, and VI are assessed by?
The child is asked to follow a toy or the examiner's finger as the object moves in all directions of gaze (six cardinal fields of gaze).
- III: Oculomotor
- IV: Trochlear
- VI: Abducens
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The Trigameal Nerve is assessed by?
CN V: The child is asked to identify a wisp of cotton on the face. Corneal reflex is tested by observing for blinking when the examiner approaches the face closely. The masseter and temporal muscles' strength can be evaluated by having the child bite down on a tongue blade as the examiner tries to remove it.
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How is the Facial Nerve assessed?
- CN VII
- The child is asked to imitate the examiner's frown, wrinkled forehead, smile, and raised eyebrow.
- The child tries to keep the eyes closed while the examiner attempts to open them, to test the strength of the eyelid muscles.
- The sensory portion of the facial nerve can be evaluated by having the child identify the taste of sugar and salt placed on the anterior part of the tongue on each side.
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CN VIII is assessed by?
- The Weber (lateral-ization) and Rinne (air and bone conduction) tests are qualitative evaluations of hearing.
- Whisper test
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How are CN IX and X assessed?
- The glossopharyngeal and vagus nerves are tested together.
- With a tongue depressor, the gag reflex is tested by touching the posterior pharyngeal wall.
- The palatal reflex is tested by stroking each side of the mucous membrane of the uvula. The side touched should rise.
- Normal function of the vagus nerve is revealed by the child's ability to swallow and to speak clearly.
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How is the accessory nerve assessed?
- CN XI
- The examiner palpates and notes the strength of the trapezius and sternocleidomastoid muscles against resistance, or the child shrugs the shoulders against resistance.
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How is the hypoglossal nerve assessed?
- CN XII
- The child is asked to stick out the tongue, and the examiner notes any lateral deviation when it is protruded.
- The strength of the tongue is assessed by having the child push against the examiner's finger pressed against the cheek with the child's tongue.
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