Q&A COUNT: 28*
GENERAL EXAMINATION:
(1) Pallor
Pallor - Grading according to IMNCI
No Palmar Pallor
Some Palmar Pallor
Severe Palmar Pallor
Safe Normal BP values which can be written by a student in Case sheet?
It is safe to write these values:
For newborn - 60/40 mm Hg
Upto 6 months - 80/50 mm Hg
After 6 months in Paediatrics - 90/60 mm Hg
Never ever write 120/80 mm Hg !!!
GENERAL EXAMINATION:
(1) Pallor
Pallor - Grading according to IMNCI
No Palmar Pallor
Some Palmar Pallor
Severe Palmar Pallor
WHO classification of anemia
Based on Hb% levels
Mild anemia 9-11 g%
Moderate anemia 7-9 g%
Severe anemia <7 g%
(2) Clubbing and Cyanosis
Grades of Clubbing
Grade 1 - Fluctuation
Grade 2- Obliteration of nail bed angle
Grade 3 - Parrot Beak appearance
Grade 4 - Hypertrophic Osteo-arthropathy
Causes of Clubbing
RS - Bronchogenic carcinoma, Cystic Fibrosis, Suppurative lung diseases, Lung carcinoma, Pulmonary AV malformation
Abdomen - Primary Biliary cirrhosis, Inflammatory bowel disease
CNS - Hemiplegia, Syringomyelia
CVS - Congenital cyanotic heart disease, Infective endocarditis, Eisenmenger's syndrome
Causes of Hypertrophic Osteoarthropathy
1. Cystic Fibrosis
2. AV malformation
3. Bronchogenic carcinoma
4. Neurofibroma
Cause for Differential Clubbing and Cyanosis
Seen in PDA (Patent Ductus Arteriosus) with reversal, where clubbing and cyanosis occurs in the lower limbs only
Mention some Typical cries of the babyBased on Hb% levels
Mild anemia 9-11 g%
Moderate anemia 7-9 g%
Severe anemia <7 g%
(2) Clubbing and Cyanosis
Age to develop clubbing
4-6 months
Which finger usually develops clubbing?
Only thumb usually develops clubbing
Cause for Pandigital clubbing
TETRALOGY OF FALLOT
Cause for Pandigital clubbing
TETRALOGY OF FALLOT
Grades of Clubbing
Grade 1 - Fluctuation
Grade 2- Obliteration of nail bed angle
Grade 3 - Parrot Beak appearance
Grade 4 - Hypertrophic Osteo-arthropathy
Causes of Clubbing
RS - Bronchogenic carcinoma, Cystic Fibrosis, Suppurative lung diseases, Lung carcinoma, Pulmonary AV malformation
Abdomen - Primary Biliary cirrhosis, Inflammatory bowel disease
CNS - Hemiplegia, Syringomyelia
CVS - Congenital cyanotic heart disease, Infective endocarditis, Eisenmenger's syndrome
Causes of Hypertrophic Osteoarthropathy
1. Cystic Fibrosis
2. AV malformation
3. Bronchogenic carcinoma
4. Neurofibroma
Cause for Differential Clubbing and Cyanosis
Seen in PDA (Patent Ductus Arteriosus) with reversal, where clubbing and cyanosis occurs in the lower limbs only
Inference about Acrocyanosis
Common and normal in newborn - then subsides
(3) Edema
(4) Typical Postures and Cries:
(3) Edema
Q2: How to differentiate Cardiac and Renal edema?
Cardiac edema occurs in Dependent parts like Pre-sacral edema (dependent part on sitting)
Q3: How to check Pre-sacral edema?
Same as how you check Pedal edema.
Done in sacral and coccyx regions**
Done in sacral and coccyx regions**
Q4: Till when, you can check pre-sacral edema?
Answer:
Till the child starts to walk (it will sit to make its pre sacral area as its dependent part)
Q5: Why facial puffiness is particularly seen in Renal disease edema, why not other edema's?
Cause is unknown**
(4) Typical Postures and Cries:
 |
| This picture is taken from Aruchamy textbook of Paediatrics |
Typical postures of child in General examination:
- CP child presents with typical posture reflecting hypertonia (scissored legs)
- TOF child presents with squatting or squatting equivalents as posture
VITALS:
How to record Axillary Temperature?
Axillary temperature is usually recorded (dont prefer recording oral temperature as baby may bite or suck it)
Bulb should be pointing upwards towards apex of axilla (if axillary temperature is recorded)
Mercury thermometer can be kept for 3-5 minutes for recording
Digital thermometer will give a Beep once it finishes recording (there is no fixed duration to keep thermometer)
Rectal , Axillary, Oral temperature - difference?
Note that: R > O > A (each by 1°F)
R - Rectal temperature
O - Oral temperature
A - Axillary temperature
Ideal Site to record core body temperature - Tympanic membrane
Temperature values in Farenheit (Oral temperature values)
Normal: 98-99° F
Febrile: >99°F (some books say > 98.8°F)
Low grade fever: 99-100.6° F
High grade fever: 101°F and above
Hypothermia: <95°F
Hyperpyrexia: >107°F
Normal Pulse Rate at various ages:
Normal Respiratory Rate at various ages:
How to record Axillary Temperature?
Axillary temperature is usually recorded (dont prefer recording oral temperature as baby may bite or suck it)
Bulb should be pointing upwards towards apex of axilla (if axillary temperature is recorded)
Mercury thermometer can be kept for 3-5 minutes for recording
Digital thermometer will give a Beep once it finishes recording (there is no fixed duration to keep thermometer)
Rectal , Axillary, Oral temperature - difference?
Note that: R > O > A (each by 1°F)
R - Rectal temperature
O - Oral temperature
A - Axillary temperature
Ideal Site to record core body temperature - Tympanic membrane
Temperature values in Farenheit (Oral temperature values)
Normal: 98-99° F
Febrile: >99°F (some books say > 98.8°F)
Low grade fever: 99-100.6° F
High grade fever: 101°F and above
Hypothermia: <95°F
Hyperpyrexia: >107°F
Normal Pulse Rate at various ages:
 |
| This picture is taken from Aruchamy textbook of Paediatrics |
Normal Respiratory Rate at various ages:
 |
| This picture is taken from Aruchamy textbook of Paediatrics |
If you observe Tachypnoea cut offs - you can see it correlates with IMNCI values for fast breathing*
How to measure BP?
Palpatory followed by Auscultatory method (as in adults)
Ideal cuff size
1. Cuff covers two thirds of length of arm
2. Inflatable bladder covers full arm cimcumference without overlapping
Cuff sizes for different ages*
2. Inflatable bladder covers full arm cimcumference without overlapping
Cuff sizes for different ages*
 |
When will you declare Hypertension in Paediatrics?
More than 90th percentile in BP chart
Less than 10th percentile - denotes Hypotension
Less than 10th percentile - denotes Hypotension
Systolic and Diastolic BP - Formula to calculate 50th percentile for particular age (for babies >1 year)
Systolic BP = 90 + (2 x age in years)
Diastolic BP = 55 + (2 x age in years)
Systolic BP = 90 + (2 x age in years)
Diastolic BP = 55 + (2 x age in years)
It is safe to write these values:
For newborn - 60/40 mm Hg
Upto 6 months - 80/50 mm Hg
After 6 months in Paediatrics - 90/60 mm Hg
Never ever write 120/80 mm Hg !!!