Questions and Answers
What does a positive Ortolani test indicate in a newborn?
Which characteristic of infants' breathing is true?
How is the posterior fontanel shaped and when does it close?
What finding is normal in newborns during examination for acrocyanosis?
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What does a positive Barlow test indicate when assessing for congenital hip dysplasia?
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Which test assesses for scoliosis in children?
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During an otoscopic exam of a child under 3 years, how should the auricle be positioned?
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What is indicated by uneven skin folds in a prone infant when tested for congenital hip dysplasia?
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What respiratory pattern is typically observed in newborns?
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What is the significance of a Trendelenburg sign test?
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What is the appropriate method to measure the heart rate in children under 7 years old?
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What indicates a right to left shunt when measuring oxygen saturation in infants?
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At what age should blood pressure measurements routinely begin in pediatric patients?
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What is the normal temperature range for children?
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What is a common physical finding in pyloric stenosis?
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How do respirations change as children age?
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Which of the following statements best describes central cyanosis in infants?
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What is a characteristic presentation of intussusception in infants?
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What does the appropriate cuff size for taking blood pressure in children refer to?
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Which condition does not typically require surgical intervention?
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Study Notes
Vital Sign Changes
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Temperature: Normal range is 97.5-99°F (36.6-37.2°C).
- Measured via axillary or oral methods; axillary requires positioning the thermometer well into the axilla.
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Heart Rate: Decreases with age; apical pulse is advisable for neonates, infants, and children with cardiac issues.
- Listen for one minute; warm stethoscope before placement over the point of maximal impulse (PMI).
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Respirations: Decrease with age; rapid in children, diaphragmatic in those under 7, and thoracic in older children.
- Monitor rise and fall of chest/abdomen for one minute; auscultation can help differentiate from heart rate.
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Blood Pressure: Increases with age, measured in children over 3.
- Cuff should take 40% of arm circumference; length should cover 80-100% of the arm circumference.
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Oxygen Saturation: Normal in children greater than 95%, measured differently in infants.
- Significant differences (greater than 2%) between pre-ductal (right hand) and post-ductal (foot) suggest shunting.
Tanner Stages
- Not elaborated but key in assessing sexual maturity in children.
Abnormal Pediatric Findings
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Pyloric Stenosis: Thickening of pylorus causing projectile, nonbilious vomiting in infants.
- Palpable firm mass in upper abdomen.
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Intussusception: Life-threatening folding of intestine impacting digestion.
- Signs include sudden inconsolable crying, knee-draw to chest, bilious vomiting, and red jelly stools.
- Umbilical Hernia: Abdominal wall failure to close; typically self-resolving without surgery.
- Diastasis Recti: Weakness between rectus abdominal muscles due to increased intra-abdominal pressure.
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Central Cyanosis: Cyanosis in central body parts indicates low blood oxygen, always abnormal in newborns.
- Acrocyanosis is normal in newborns, manifesting as cyanosis in hands and feet.
Fontanels
- Anterior Fontanel: Diamond-shaped, flat, closes by 18 months; bulging or depressed indicates abnormalities.
- Posterior Fontanel: Smaller, triangular, closes at 6-8 weeks.
Otoscopic Exam Differences
- In children over 3, pull auricle up and back; under 3, pull down and back due to ear canal curvature.
Breathing Differences
- Infants are nasal breathers; under 7 are diaphragmatic; over 7 are thoracic breathers.
Congenital Hip Dysplasia Tests
- Ortolani Test: Detects dislocated hip; a 'clunk' indicates positive.
- Barlow Test: Attempts to dislocate hip; positive if hip can be dislocated.
- Galeazzi Sign: Check knee level with legs flexed; unequal knees suggest dysplasia.
- Unequal Skin Folds: Assessed in prone position; difference indicates potential dysplasia.
Scoliosis Testing
- Adam's Bend Forward Test: Evaluates spinal curvature; a degree of 7 or more warrants further investigation.
- Trendelenburg Sign: Pelvis tilting indicates weakness of hip abductors or dysplasia.
Infant Chest and Breathing
- Infants have a barrel chest and a 1:1 A/P to transverse diameter ratio.
- Chest circumference is less than head circumference until 1 year.
- Breathing patterns include longer inspirations and irregular rates; tachypnea is the first sign of distress.
- Wheezing during respiration highlights airway obstruction; inspiratory indicates high obstruction.
Reflexes
- Babinski Reflex: Dorsiflexion of great toe with fanning occurs in newborns; disappears by 12-18 months.
- Moro Reflex: Startle response with arms spread; disappears by 4 months.
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Description
Test your knowledge on how vital signs change with age in pediatrics. This quiz covers proper techniques for measuring temperature, heart rate, and understanding what normal values are. Perfect for medical students and healthcare professionals!
