Systemic Examination
Q&A COUNT: 20*
Heaving - AS
Hyperdynamic - MR
Diffuse apical impulse - left ventricular aneurysm
Double apical impulse - AS + AR
Triple apical impulse - HOCM
Quadruple apical impulse - HOCM
Difference between Tapping, Heaving and Hyperdynamic apical impulse
Tapping - confined to one Intercostal space
Hyperdynamic - diffused over more than Intercostal space, ill sustained (for duration less than 2/3rd of systole)
Heaving - diffused over more than Intercostal space, well sustained (for duration more than 2/3rd of systole)
Murmur - Gradings
Causes of Tender hepatomegaly?
Q&A COUNT: 20*
CVS Examination: 05
(Q) What is apical impulse?
Lowermost and Outermost point of definite cardiac impulse, which gives maximum thrust to the palpating finger
(Q) How apical impulse position varies with age?
INFANCY - In the left 4th Intercostal space, just "lateral" to the midclavicular line
(then)
UPTO 5 YEARS - In the left 5th Intercostal space, along the midclavicular line
(then)
AFTER 5 YEARS & ADULTS - In the left 5th Intercostal space, just "medial" the midclavicular line
Types of Apical Impulse
Tapping - MSHeaving - AS
Hyperdynamic - MR
Diffuse apical impulse - left ventricular aneurysm
Double apical impulse - AS + AR
Triple apical impulse - HOCM
Quadruple apical impulse - HOCM
Difference between Tapping, Heaving and Hyperdynamic apical impulse
Tapping - confined to one Intercostal space
Hyperdynamic - diffused over more than Intercostal space, ill sustained (for duration less than 2/3rd of systole)
Heaving - diffused over more than Intercostal space, well sustained (for duration more than 2/3rd of systole)
Murmur - Gradings
Grade 1 to 6
Grade 1 -very soft, can be heard in a quiet room
Grade 2 - soft, but easily audible
Grade 3 - moderate, no thrill
Grade 4 - Loud with thrill
Grade 5 - Very loud with thrill, murmur heard with stethoscope barely placed on chest wall
Grade 6 - Loud and audible with stethoscope just off the chest wall
Grade 1 -very soft, can be heard in a quiet room
Grade 2 - soft, but easily audible
Grade 3 - moderate, no thrill
Grade 4 - Loud with thrill
Grade 5 - Very loud with thrill, murmur heard with stethoscope barely placed on chest wall
Grade 6 - Loud and audible with stethoscope just off the chest wall
(Q) Murmurs in different congenital heart diseases?
ASD - ESM in pulmonary area + MDM in tricuspid area
VSD - PSM, left sternal border (at 3rd and 4th IC spaces)
PDA - Continuous Murmur (in left 2nd IC space - in Gibson's area)
TOF - ESM (Left 3rd and 4th IC space)
TOF with cyanotic spell - ESM murmur decreases with intensity or becomes absent*
VSD - PSM, left sternal border (at 3rd and 4th IC spaces)
PDA - Continuous Murmur (in left 2nd IC space - in Gibson's area)
TOF - ESM (Left 3rd and 4th IC space)
TOF with cyanotic spell - ESM murmur decreases with intensity or becomes absent*
RESPIRATORY SYSTEM:
How to draw?
- Bronchial breathing - (a)
- Vescicular breathing - (b)
- Broncho vescicular breathing - (c)
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| This picture is taken from Aruchamy textbook of Paediatrics |
Abdomen:
Normal Palpable organs in Newborn
Liver and Full bladder are normally palpable in newborn
Normal liver span variations with age
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| This picture is taken from Aruchamy textbook of Paediatrics |
Grades of Hepatomegaly
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| This picture is taken from Aruchamy textbook of Paediatrics |
Causes of Tender hepatomegaly?
- Dengue
- Hepatitis etc
How to measure Liver span?
Upper border of liver at midclavicular line is found and marked by percussion
Lower border of liver at midclavicular line is found and marked by palpation
Measure distance between those 2 points - You will get the Liver span!
Renal angle tenderness - Causes:
Answer:
Pyelonephritis
Pyonephrosis
Hydronephrosis
Any mass
Boundaries of Renal angle
Located between the lateral border of erector spinae muscle and inferior border of the twelfth rib
CENTRAL NERVOUS SYSTEM:
Root values of JERKS
Biceps reflex C5,C6
Supinator reflex C5,C6
Triceps reflex C6,C7,C8
Knee jerk L2,L3,L4
Ankle jerk S1,S2
Plantar reflex in children?
Positive Babinski sign (Extensor Plantar Reflex) - due to lack of myelination in Corticospinal tract upto 2 years
Cranial nerve examination in Paediatrics
CN 1 - Subjective test requiring co-operation from child (done as same as in adults); In newborns, check if baby can turn towards smell of breastmilk
CN 2 - Check for gross vision** + Visual acuity + Color vision + Visual field + Light reflex + Menace reflex
CN 3 - Same as adults + check for Doll's eye movement
CN 4,5,6 - Same as adults
CN 7 - same as adults + Sucking reflex**
CN 8 to 12 - Same as adults
Test for Gross Vision:
Test if the child is able to recognize parents or objects or strangers, test whether child smiles at mother or not
Test if the child is able to follow objects
Menace Reflex:
Fingers are taken towards eyes. There should be normal blinking and withdrawl of head away from the stimulus
Doll's eye movement:
Turn the head to one side. When brainstem is intact, eye balls move in a direction opposite to that of head movement
How to do Moro reflex? (or) What are the 3 components of Moro reflex?
With baby supported in supine position, head is allowed to fall backward for a few centimetres.
The reflex involves 3 COMPONENTS
1. Opening of hands* and
2. Sudden abduction and extension of arms*
3. This is followed by - anterior flexion at shoulder joint
Moro reflex disappears by 3-6 months*
Gestational Age of appearance of 3 components of Moro reflex and its importance
Hand opening - 28 weeks
Extension and abduction - 32 weeks
Anterior flexion - 37 weeks
Significance:
3rd component of Moro reflex is absent in Preterm, due to weak antigravity muscles
List of Immature Newborn reflexes
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| This picture is taken from Aruchamy textbook of Paediatrics |