Pocket Tutor Paediatric Clinical Examination Rossa Brugha, Keir Shiels
INDEX
ABCDEFGHIJKLMNOPQRSTUVWXZ
Note: Page numbers in bold or italic refer to tables or figures respectively.
A
ABC approach, primary survey 206
Abdomen
auscultation 142–143
inspection 138–140, 139
newborn 27
palpation 140–142
percussion 142
Abdominal conditions 122, 125
abdominal mass/distension 134, 135
abdominal pain 125–129
diarrhoea 131–133
rectal bleeding 133–134
vomiting 129–131, 130
Abdominal examination 135
abdomen 139–143
chest 138–139
exposure 136
eyes 138
general assessment 136, 137
hands 136
implants for feeding 136, 137, 141
investigations 143
mouth 138
neck 138
pulses and BP 136
scars from previous surgery 137
sequence 135–136
summary of 144
Abdominal mass 134
causes of 135
inguinal hernias 134
Abdominal pain 125, 126
appendicitis 123–124, 127
colic 128
constipation 125
inflammatory bowel disease 128
intussusception 128
testicular torsion 129
urinary tract infection 126–127, 127
Abdominal radiographs 143
Abducens nerve (CN VI) 168
CN VI palsy 149, 168
Absence seizure 152
Abuse 37
signs on examination 37–38
Accessory nerve (CN XI) 172
Achondroplasia 296
Acute disseminated encephalomyelitis (ADEM) 156
Acute otitis media 219–220
Adult-onset polycystic kidney disease 298
Alcohol 300, 302
Allergy, facial swelling in 215, 216
Amniocentesis 17
Anal atresia 18
Angelman syndrome 294–295
Angiotensin-converting enzyme inhibitors 302
Anhedonia 266
Anorexia nervosa 272–273
Anoxic seizures 114
Antenatal fetal scanning 103
Antenatal history 7
Antenatal infections, syndromes by 301, 304
Anxiety 268–269
Apgar score 13, 13
Aphthous ulcers 138
Appendicitis 123–124, 127
Areflexia 176
Arthrogryposis 301, 303
Ascites 142, 142
Ash leaf macules 163, 163
Asterixis 95
Asthma 266
Asymmetrical tonic neck reflex 180
Ataxia 145–147, 156–157, 178
causes of 156
Athetoid movements 165
Atrial septal defect (ASD) 108
Atrioventricular septal defect 113
Atrophic glossitis 138
Attention deficit hyperactivity disorder (ADHD) 269
Auscultation
abdomen 142–143
chest 99–100, 119–120, 120
neck 231
Autism spectrum disorder 270–271
Autosomal dominant syndromes 295, 296–297
Autosomal recessive syndromes 298–300, 299
Auxology 56
arm span 58
growth velocity 60, 60
head circumference 57, 58
height/length 56, 57
weight 58–59
Avascular necrosis of femoral head see Perthes’ disease
Avulsion fractures 193, 194
Axillary freckles 163
B
Babinski sign 180
Back pain 158
Bacterial conjunctivitis 217
Bacterial endocarditis 110
Barber's chair phenomenon 159
Barking cough 90
Barlow test 31, 32, 33
Becker muscular dystrophy 77
Behavioural examination 275, 281
affect 278–279
appearance and manner 276
ASTHMATICS approach 276
cognition 279–280
environment and ethics in 275
focused history from child and parent 275
hunger 278
insight 279
investigations 280–281
mood 278
sleep 280
social behaviour 277
summary of 281
thought content 277–278
toilet 279
Behavioural presentations 261, 264–265
abnormal interaction 269–271
continence, abnormal 274–275
eating habits, abnormal 271–274
fatigue 265–268
hyperactivity 262–263, 268–269
low mood 263–264
Bell's (facial nerve) palsy 21, 170, 170
Benign constitutional delay 74–75
Benzodiazepines 302
Bilirubin level, in newborn 19
Birth history 7
Birthmarks 255, 255
Blood pressure, measurement of 121
Bordetella parapertussis 91
Bordetella pertussis 91
Bossing 305, 306
Bottom-shuffling 75
Botulism 154
Bowel sounds 142–143
Brachial plexus injury 25
Brain tumours 150
Breastfeeding see also Breast milk
benefits of 45
contraindications to 46
Breast milk
advantages of 45, 45
from bottles/donor 46
maternal immunoglobulin (IgA) in 49
Breath-holding attacks 270
Breath sounds 26
Breath, sweet-smelling 138
Bronchial breathing 99
Bronchiolitis 83–84
Buckle fracture 186, 187
Bullous impetigo 250, 251
Button battery ingestion 273, 273
C
Café-au-lait spot 163
Calorie intake, inadequate 51
behavioural feeding problems 52
inadequate offered milk 52
weaning failure 52
Cancers of musculoskeletal system 190
Candidiasis 242
Cardiac disease 103
cardiomyopathy 115
common presentations 107
cyanotic newborn 111–113
duct-dependent cyanotic heart disease 106
heart failure 113, 113
heart murmurs 103–105, 107, 107–110
long QT syndrome 105–106, 115
palpitations and collapse 114–115
supraventricular tachycardia 114–115
syncope 114
Cardiac examination 116
auscultation 119–120, 120
back and abdomen 121
exposure 116
eyes 118
general assessment 116
hands 116–117, 117
investigations 121–122
jugular venous pulse 118
mouth and tongue 118, 119
precordium 118
pulses and blood pressure 118
sequence 116
summary 122
Cardiomyopathy 115
Cellulitis 239, 239
Centripetal obesity 138
Cephalhaematoma 20
Cerebellar lesions 179
Cerebellum, examination of 177–179
ataxia 178
DANISH mnemonic 177
dysdiadochokinesia 177–178
hypotonia 179
intention tremor 178–179
nystagmus 178
speech difficulty 179
Cerebral palsy 155–156
Chest
abdominal disease, signs of 138–139
examination of (see Chest examination)
expansion 96, 97, 99
pain in children 107
sounds 96
Chest examination 95
auscultation 99–100
inspection 96, 96, 97
palpation 96–98, 97
percussion 98, 98–99, 99
sequence 95
Chickenpox 247–248, 248
Child
examination of (see paediatric examination)
irritable vs. unsettled 161
Chlorpheniramine 105
Choanal atresia 21, 51
Choreas 165
Chorionic villus sampling 17
Chronic fatigue syndrome 267–268
Chronic illness, and growth delay 55
Clinodactyly 25
Clonus 174
Clostridium botulinum 154
Clubbing 93, 94, 117, 117
abdominal disease and 136
cardiac conditions associated with 117
Coarctation of aorta 27, 109, 110
Cocaine 302
Cochlear implant 228, 229
Coeliac disease 133
Colic 128
Communication, in history taking 3
with child and accompanying adult 3–4
language for 4
Congenital adrenal hyperplasia 28
Congenital cardiac disease 103
Congenital infection syndromes 301, 304
Congenital syndromes, and development delay 76–77
Conjunctivitis 217–218
Constipation 125
Constitutional delay of growth 54
Constitutional pubertal delay 48–49
Coryza 87
Cough 89
features of 90
gastro-oesophageal reflux 90
habitual cough 92
pneumonia 89–90
tuberculosis 91–92
whooping cough 91
Cover test 168–169, 169
Cranial nerve (CN) examination 166–173
eye movements (oculomotor, trochlear and abducens) 168, 168–169
face (trigeminal and facial) 169–171, 170, 171–172
hearing and balance (vestibulocochlear) 172
neck movements (accessory) 172
oropharynx (glossopharyngeal, vagus and hypoglossal) 172–173
smell (olfactory nerve) 166
vision (optic nerve) 166–168
Cranial nerve palsy 167
Craniosynostosis syndromes 296, 305, 307
Crohn's disease 128
Croup 84–85, 88
inspiratory stridor and barking cough 85
modified Westley scoring system for 86
Cyanosis 93, 118, 119
Cyanotic heart disease 111
Cystic fibrosis 83, 283
Cytomegalovirus 304
D
DALEK mnemonic, for fat-soluble nutrients 52
Decerebrate posturing 164
Decorticate posturing 164
Deep tendon reflexes 176, 177
Dehydration, severe, clinical features of 133
Depression 266
Dermatological examination 255–256
colour of rash 257
distribution of lesions 256–257
easily overlooked areas 259–260
fluid-filled lesions 258
general inspection 256
palpation 258–259
shape and pattern 258
size of lesion 258
summary of 259
Developmental assessment 78
communication 80
environment for 79
fine motor skills 80
general inspection 78–79
gross motor skills 80
investigations 82
multidisciplinary approach 81, 81
screening questions 79
social/activities of daily living 81
summary of 82, 82
Developmental delay 65–68, 74, 74
Developmental dysplasia of the hip 31
Developmental follow-up 77–78
Developmental milestones 68–70, 69–70, 71, 72, 73
red flags 68, 73
Developmental regression 74, 74
Diarrhoea 131–133
acute 131
chronic 124–125, 131, 132
differential diagnoses 131–132
gastroenteritis 132–133
malabsorption 133
DiGeorge syndrome 292
Dimercaptosuccinic acid (DMSA) scan 127
Distraction techniques 39
Down's syndrome 283, 287, 288, 289, 309
low-set ears in 20
palmar crease in 25
Dry cough 90
Duane syndrome 168
Duchenne's muscular dystrophy 67, 77
Ductus arteriosus 103, 104
Dysdiadochokinesia 177–178
E
Ear examination 232–233
inspection 232–233
positioning for 232, 232
Ear, nose and throat (ENT) examination 228
ear examination 232, 232–233
exposure 228
general assessment 228, 228, 229
neck examination 230, 230–231
nose examination 233, 233–234
oropharynx examination 234, 234–235, 236
summary of 236
Ear pain 219–220
acute otitis media 219–220
mastoiditis 220
otitis externa 220
otitis media with effusion 220
Ears, low-set 308, 308
Eating disorders 52
Eating habits, abnormal 271–274
anorexia nervosa 272–273
fussy eating 271, 272
pica 273–274
ECG 121–122
Echocardiography 122
Eck stiffness, and neck pain 150
Eczema 240
Eczema herpeticum 248, 249
Edwards’ syndrome 288, 290
Ehlers–Danlos syndrome 296
Elbow, subluxed 183
Empyema 89
Encopresis 274–275
Endocarditis 117
Environment, for clinical examinations 38, 38–39
Epididymo-orchitis 129
Epiglottitis 87
Epilepsy 151–152
Epistaxis 223–224
foreign body in nose 224
mucosal trauma 223
systemic coagulopathy 224
Epstein–Barr virus 222
Erb's palsy 25
Erythema chronicum migrans 247, 247
Erythema nodosum 253, 254
Erythematous maculopapular lesions 243–247, 244
Kawasaki's disease 245–246, 246
Lyme disease 247, 247
measles 245, 245
scarlet fever 246–247
Erythematous rashes 239–240
Erythema toxicum 14, 22, 24
Escherichia coli 126
Eye see also Facial/eye swelling
abdominal disease in, signs of 138
movement defects 168, 168–169
F
Facial dermatomes 169, 170
Facial/eye swelling 215–218
allergy 215, 216
conjunctivitis 217–218
mumps 216–217
nephrotic syndrome 215–216, 217
orbital cellulitis 218
periorbital cellulitis 218, 219
Facial nerve (CN VII) 170, 170–171, 171–172
Failure to thrive 47–48
Fainting see Syncope
Faltering weight 51
defined 51
excess losses 52–53
lack of intake 51–52
vitamin and iron deficiencies 52, 53
Family tree, construction of 9, 9
Fatigue 265–268
chronic fatigue syndrome 267–268
depression 266
lethargy 266, 267
sleepiness 265, 265
Fat-soluble vitamins 52
Febrile convulsions 151
Fetal alcohol syndrome 17, 300, 300–301
Fetal blood circulation 103, 104
Fetal distress, history of 18
Foreign body, inhaled 86
Foreign body in nose 224
removal of 224
Fracture 206, 206
assessment of 207
open fracture 206–207
ossification centre on radiograph 208, 209
Salter–Harris classification of 207
supracondylar fracture 207, 208
Fragile X syndrome 297, 298
Fungal infections, of skin 241, 241, 242
Fussy eating 271, 272
G
Gait abnormalities 165, 165–166
Gastroenteritis 132–133
Gastro-oesophageal reflux 90, 130–131, 266
Genetic disorders and syndromes 283 see also Paediatric syndromic examination
autosomal dominant syndromes 295, 296–297
autosomal recessive syndromes 298–300, 299
congenital abnormalities 283
genetic conditions 283
inherited conditions 283
karyotype disorders 286–290
microdeletion syndromes 290, 292–295
presentations of 286
short stature 284–285
unusual behaviour 285–286
X-linked syndromes 295, 297–298
Genitalia, newborn
boys 28
girls 28
Genu valgum 204
Genu varum 204
Gestational diabetes 16
Glasgow Coma Scale 161, 162
Global delay 76
Glossopharyngeal nerve (CN IX) 172
Gower's sign 176
Grasp reflex 25, 26, 180
Graves’ disease 16, 226, 227, 268
Grommets 220
Group B streptococcal colonisation 16
Growing pains 192–193, 194
Growth 45
examination of (see Growth examination)
poor growth 46–47
rate of, variations in 45
recording of 47, 47
Growth, abnormal 53
abnormal stature 54–55
disproportionate head circumference 53–54, 54
Growth chart 47, 47, 56, 256
Growth examination 56
auxology 56–61
general inspection 56
investigations 62
pubertal status 61–62, 62, 63
summary of 64
systems review 61
Growth hormone abnormalities 55
Growth problems 49
abnormal growth pattern 53–55
faltering weight 51–53
neonatal weight loss 49–51
Growth spurts 192
Growth targets 60
body mass index (BMI) 61
centiles 60–61
mid-parental height 61
Growth velocity, reduced 48–49
Grunting 37
Guillain-Barré syndrome 147–148, 159
Gynaecomastia 138
H
Habitual cough 92
Haemarthrosis 191
Haemoptysis 90
Hand, foot and mouth disease 249
Hands examination 93, 116–117, 117
abdominal disease, signs of 136
asterixis 95
clubbing 93, 94, 117, 117
cyanosis 93
pulse 94, 118
splinter haemorrhages 117
Harrison's sulcus 96
Headache 145, 149–151
intracranial tumour 150–151
migraine 150
tension 149–150
Head and neck, presentations in 213, 215
epistaxis 223–224
facial/eye swelling 215–218
neck lumps 224–227
painful ear 219–220
sore throat 220–222
Head circumference, abnormal 53–54
causes of 54
macrocephalic 53
microcephalic 53
Hearing tests 233
Heart failure 113, 113
Heart murmurs 26, 103, 107–110
atrial septal defect 108
causes 107–108
coarctation of aorta 109, 110
grading intensity of 120
innocent murmur 104–105
by location 107
patent ductus arteriosus 109
pathological murmur 104
valve defects 110, 110
ventricular septal defect 108, 108–109
Heart sounds 119, 120
fixed splitting 120
listening to 26, 26
splitting of second heart sound 120
Henoch-Schönlein purpura 237–238, 252, 254
Hip, assessment of 201–203, 203
adduction and abduction 201, 202
antalgic gait 201
causes of hip pain 203
flexion and extension 201, 202
internal and external rotation 201, 203
Hirschsprung's disease 18, 125
History, components of 5
antenatal history 7
birth history 7
developmental history 7
drug and allergy history 6
family and social history 9, 9–10
immunisations 7–9, 8
past medical history 6
presenting complaint 5–6
summary and questions 10
systems review 10
History taking 1
active observation during 4
communication in 3–4
interpreter in, use of 4
preparation for 2
red flags symptoms 10–11, 11
in respiratory distress 1–2
settings for 2
Holter monitoring 122
Hundred day cough 91
Hyperactivity, in children 262–263, 268–269
anxiety 268–269
attention deficit hyperactivity disorder 269
hyperthyroidism 268
Hypertelorism 307
Hyperthyroidism 268
Hypertonia 155–156
acute disseminated encephalomyelitis 156
cerebral palsy 155–156
Hypertrophic obstructive cardiomyopathy 115
Hypoglossal nerve (CN XII) 173
Hypothyroidism 75
Hypotonia 152–155, 173, 179
botulism 154
differential diagnoses 152–153, 153
poliomyelitis 154
spinal muscular atrophy 153–154
stroke 154–155
and weakness 152
Hypoxia, and cyanosis 93
Hypoxic–ischaemic encephalopathy 30
I
IgA deficiency 133
Immunisations
and controversies 8–9
history taking 7–8
vaccination schedule for children 8
Imperforate anus 30
Infant skull, normal sutures of 306
Inflammatory bowel disease 128
Inflammatory diarrhoea 132
Inguinal hernias 134
Inspection
abdomen 138–140, 139
chest 96, 96, 97
ear 232–233
limbs 164–165
neck 230
nose 234
oropharynx 235
Intention tremor 178–179
Interferon-γ release assays 91
Intracranial pressure, raised 150
Intracranial tumour 150–151
Intussusception 128
Iron deficiency 51
Irritable hip see Transient synovitis
J
Jaundice 138
in newborn 15, 19
Joint effusion 185
Jugular venous pressure (JVP) 118
Juvenile idiopathic arthritis 191–192
K
Karyotype 286
Karyotype disorders 286–287
Down's syndrome 287, 288, 289
Edwards’ syndrome 288, 290
Kleinfelter's syndrome 289–290
Patau's syndrome 288, 290
Turner's syndrome 288–289, 291, 291
Kawasaki's disease 245–246, 246
Kayser–Fleischer rings 138
Kerion 240, 241
Kleinfelter's syndrome 289–290
Klippel–Feil disease 201
Klumpke's palsy 25
Knee, assessment of 203–205, 204, 205
appearance 204
approach 203–204
associated conditions 204–205
cruciate ligaments, testing 205
test for collateral ligament instability 204
Koilonychia 136
Koplick's spots 245
L
Lactation difficulties 50
Lactose intolerance 50
Laryngomalacia 86–87
Laryngotracheobronchitis see croup
Lazy’ eye 148–149
Lead poisoning 160
Learning difficulties 76
Lethargy 265, 266
causes of 267
Leucocoria 21, 22
Leukonychia 136
Limb pain 189
Limbs, examination of 173–177
power 174–176, 175
sensation 177, 178
tendon reflexes 176, 177
tone 173–174, 174
Limbs inspection 164–165
asymmetry 164
dyskinesias 165
fasciculation 165
hypertrophy 164
limb position 164
posture 164
scars 165
wasting 164
Limp 184, 185–190
causes of 186, 186
malignancy 190
osteomyelitis 188
Perthes’ disease 188–189, 189
septic arthritis 187–188, 188
slipped upper femoral epiphysis 189–190, 190
transient synovitis 186–187
Lithium 17, 302
Long QT syndrome 105–106, 115
‘Look, feel, move’ approach, for joint examination 195–197
active movement 196
bruising 196
crepitus 197
deformity 195
erythema 196
fluid thrill 197
guarding 195
joint palpation 196
posture 195
swelling 195
temperature 196
Low-set ears 308, 308
Lyme disease 169, 247, 247
Lymphadenopathy 224–226, 226
infectious 225
malignant 226
M
Macrocephaly 54, 305
Malabsorption, diet-related 133
Malabsorptive diarrhoea 132
Malignant lymphadenopathy 226
Maltreatment, child 209–210
Mantoux test 91
Marfan's syndrome 296
Mastoiditis 214, 220, 221
Maternal history 15–17, 16
Measles 245, 245
Measles, mumps and rubella (MMR) vaccine 8
Meckel's diverticulum 134
Meconium 18, 30
Meningococcal septicaemia 250–252, 253
Mercaptoacetyltriglycine (MAG-3) scan 127
Mesenteric adenitis 128
Microcephaly 54, 305
Microdeletion syndromes 290, 292–295
Angelman syndrome 294–295
Prader–Willi syndrome 294–295
22q microdeletion syndrome 292–293, 293
Williams’ syndrome 293–294, 294
Micturating cystourethrogram 127
Migraine 150
Mobility, lack of 76
Molluscum contagiosum 249–250
Moro reflex 179
Multiple endocrine neoplasia 296
Multiple sclerosis 159
Mumps 216–217
Muscular dystrophy 76–77, 164
Musculoskeletal examination 193–194
child maltreatment 209–210
fracture, assessment of 207–209
general inspection 194–195
hip 201–203, 202, 203, 203
knee 203–205, 204, 205
look, feel, move approach 195–197
pGALS examination 197–200
sequence for 194
spine 200–201
summary of 211
in trauma setting 206, 206–207
Musculoskeletal presentations 185
acute limp 184, 185–190
polyarthritis 191–193
single joint swelling 190–191
subluxed elbow 183
Mycobacterium tuberculosis 91
N
Napkin dermatitis see Nappy rash
Napoleon posture 25
Nappy rash 240
Nasal flare 37
Nasal mucosa 223
Nasogastric tube 141
Nasojejunal tube 141
Neck examination 230–231
active movements 231
auscultation 231
inspection 230
palpation 231
positioning for 230, 230
swallowing 231
Neck lumps, in children 224
differential diagnosis of, based on anatomical location 225
lymphadenopathy 224–226, 226
thyroid disease 226–227, 227, 227
Neglect, child 65–66, 76
Neonatal abstinence syndrome 17
Neonatal hypoglycaemia 16
Neonatal weight loss 49–51
congenital causes 50–51
feeding difficulties 50
increased metabolic demand 51
milk allergy or lactose intolerance 50
physical barriers to feeding 50–51
Nephrotic syndrome 215–216, 217
Neurocutaneous markers 163, 163
Neurocutaneous syndromes 77
Neurofibromatosis 296
Neurological conditions 145, 148
altered sensation with weakness 157–160
ataxia 156, 156–157
headache 149–151
hypertonia 155–156
hypotonia 152–155
lazy’ eye 148–149
seizures 151–152
weakness 152
Neurological examination 145, 160
approach to 145
cerebellar examination 177–179
conscious level 161–162, 162
cranial nerve examination 166–173
exposure 160
gait assessment 165, 165–166
general appearance 161
limb appearance and leg length 164–165
limbs examination 173–177
mobility 163–165
primitive reflexes 179–180
sequence for 160
skin 163, 163
summary of 181
Neurometabolic conditions 77
Newborn
cyanotic 111–113
drugs taken by mother, effect of 17
with jaundice 15
maternal conditions on, effect of 15–17, 16
with rash 14
Newborn examination 13, 18–19
abdomen 27, 27
anus 30
appearance 19–20
arms 25
blue spot birthmarks 28, 29
chest 26
clavicles 25
at delivery 13, 13
ears 20
eyes 21, 22
femoral pulses 27
fetal history and 15–18
formal neonatal check 14
genitalia 28
groin 28
hands 25, 25–26
heart 26, 26
hips 31–34, 33
legs 28, 28–29
maternal history and 15–17, 16
muscle tone and movements 20, 20
nose and mouth 21, 23
reflexes 30, 31
skin 22, 24
skin colour 19, 19
skull 20, 21
spina bifida 29, 29–30
summary of 34, 34
at 6–8 weeks 14
Nocturnal cough 90
differential diagnosis for 266
Nocturnal enuresis 274
Non-paralytic squint 168, 168
Noonan's syndrome 284, 295, 297
Nosebleeds see Epistaxis
Nose examination 233–234
inspection 234
positioning for 233, 233
Nose picking 233
Numbness and tingling with weakness 157–160
Guillain-Barré syndrome 159
lead poisoning 160
multiple sclerosis 159
spinal tumour 157–158
transverse myelitis 158, 158
Nystagmus 178
O
Object permanence 80
Obstructive sleep apnoea 266
Occipitofrontal circumference, measurement of 20, 21, 305
Oculomotor nerve (CN III) 168
CN III palsy 168
Olfactory nerve (CN I) 166
Omphalitis 27
Omphalocoele 27
Opiates 302
Optic nerve (CN II) 166–167
Orbital cellulitis 218
Orchidometer 61, 63
Oropharynx examination 234, 234–235, 236
inspection 235
positioning for 234, 234–235
tonsils 235, 236
Orthostatic hypotension 114
Ortolani test 32, 33, 34
Osgood–Schlatter's disease 193, 194
Osteomyelitis 188
Osteopenia 75
Otitis externa 220
Otitis media with effusion 220
Otoscope 232
Oxygen saturation 121
P
Paediatric examination
abused child, recognising 37–38
age-appropriate approach and language 39–40, 40
challenges in 35–36
chaperone presence during 42
crying baby, examining 41
cultural considerations 41
environment and equipment 38, 38–39
guiding principles 43
nurses and play specialists 39
parents, role of 40–41
physiological normal values 36
red flag signs 37
sick child, recognising 36
unhappy toddler, examining 41–42, 42
Paediatric ‘gait, arms, legs and spine’ (pGALS) examination 197–200
arms 197–198, 198
Beighton score 199–200
gait 197
legs 198
spine 199, 199
Paediatric syndromic examination 302–303, 309–310
ears 308, 308
eyes 307, 307
general inspection 303–304
genitalia 309
head 304–307, 305, 306
limbs 309
mouth, nose and philtrum 308
summary of 310
thorax 308–309
Pallor
of conjunctivae 138
of palmar creases 136
Palpation
abdomen 140–142
chest 96–98, 97, 118
joint 196
lymph nodes in neck 95
neck 231
newborn abdomen 27
Palpitations 114
Paralytic squint 168, 168
Parenting classes 262
Parotid swelling 216
Paroxysmal cough 90
Patau's syndrome 288, 290
Patellar tap test 197
Patent ductus arteriosus (PDA) 109
Pectus carinatum 26, 96
Pectus excavatum 26, 96
PEG button 141
PEG-J tube 141
PEJ tube 141
Percentage dehydration 132
Periorbital cellulitis 218, 219
Periorbital oedema 138
Peritonsillar abscess see Quinsy
Perthes’ disease 188–189, 189
Petechiae 250
Peutz–Jegher syndrome 138
Phlebitis 239
Pica 273–274
Pityriasis rosea 242, 243
Plagiocephaly 305, 306
Plantar reflex 180
Play specialists 39
Pleural effusion 89, 90
Pneumonia 89–90
Pneumothorax 26
Poland syndrome 301
Poliomyelitis 154
Polyarthritis 191
growing pains 192–193, 194
juvenile idiopathic arthritis 191–192
rheumatic fever 192, 193
Portacath site 96, 97
Port-wine stain 163
Posterior nasal drip 266
Pott's disease 91
Power, in muscle groups 174–176
arms 174–175
legs 175–176
Medical Research Council grading system 175
Prader–Willi syndrome 294–295
Precocious puberty 55
Prematurity, classification of 17, 18
Presenting complaint 5
history of 5–6
TENDS mnemonic, use of 5–6
Primitive reflexes 179
asymmetrical tonic neck reflex 180
grasp reflex 180
Moro reflex 179
plantar reflex 180
rooting and sucking reflexes 180
stepping reflex 180
Productive/fruity cough 90
Prostaglandin E, in duct-dependent cardiac defect 106, 111
Pseudosquint 168, 168
Psoriasis 240
Pulse examination 94, 118
Pupillary reflex 167
Pupuric/petechial rashes 250
erythema nodosum 253, 254
Henoch-Schönlein purpura 252, 254
leukaemia 254–255
meningococcal septicaemia 250–252, 253
thrombocytopenic purpura 252–253
Pyloric stenosis 131
Q
22q microdeletion syndrome 292–293, 293
Quinsy 222, 223
R
Rapid eye movement (REM) sleep 265
Rash 237, 238
dry/flaking 240–242
erythematous 239–240
erythematous maculopapular lesions 243–247
pupuric/petechial 250–255
urticaria 242–243
vesicobullous lesions 247–250
Reactive arthritis 191
Recession 37
Rectal bleeding 133–134
Rectal examination, in children 143
Red reflex 21, 22, 167
Referral letters 2
Reflexes, newborn 30
Moro reflex 30, 31
stepping reflex 30, 32
Relative afferent pupillary defect 167
Respiratory distress 26, 37
types of 37
Respiratory examination 92
chest 95–100
general inspection 92–93
hands 93–95, 94
head and neck 95
investigations 101
sequence 92
summary 100
Respiratory illness
bronchiolitis and poor feeding 83–84
presentations 85–92
probable diagnoses of 83
stridor and noisy breathing 84–85
Respiratory rate 93
Retinoic acid derivatives 302
Rett's syndrome 271, 297–298, 299
Rheumatic fever 115, 192
Duckett Jones criteria for 193
Rickets 75
Rickety rosary 61
Rooting reflex 180
Rotavirus vaccine 132
Rubella 304
S
Sarcoptes scabiei 242
Scabies 242
Scaphocephaly 306, 307
Scarlet fever 213–214, 222, 246–247
Scrofula 91
Secretory diarrhoea 132
See-saw breathing 37
Seizures 151–152
differential diagnosis 151
epilepsy 151–152
febrile convulsion 151
focal 151–152
generalised 152
hypoglycaemia and 151
Sensory ataxia 157
Sensory problems 75
Sensory/speech impairment 270
Sepsis in newborn, risk factors for 15
Septal haematoma 233
Septic arthritis 187–188, 188
Shagreen patch 163
Shingles 247–248, 248
Skin, examination of see Dermatological examination
Slipped upper femoral epiphysis 189–190, 190
Snellen chart 167
Social withdrawal 266
Sodium valproate 17, 302
Sore throat 213–214, 220–222
quinsy 222, 223
tonsillitis 221–222, 222
Spacer device 88, 89
Spasticity see Hypertonia
Speech delay 67–68
Speech difficulty 179
Spider naevi 138
Spina bifida 29, 29–30
Spinal muscular atrophy 153–154
Spinal tumour 157–158
Spine, assessment of 200
cervical spine 200–201
lumbosacral spine 201
thoracic spine 201
Splinter haemorrhages 117
Squint 168, 168
Staphylococcus aureus 188, 218, 250
Stature, abnormal 54–55
constitutional delay of growth 54
familial stature 54
genetic syndromes 55
growth hormone abnormalities 55
pubertal dysregulation 55
Stepping reflex 180
Stevens-Johnson syndrome 250, 252
Strabismus (squint) 148, 149
non-paralytic 149
paralytic 149
pseudosquint 149
Strawberry tongue 222, 260
Streptococcus pyogenes 188, 222
Streptomycin 302
Stridor 84–85
croup 85, 86
epiglottitis 87
inhaled foreign body 86
laryngomalacia 86–87
Stroke 154–155
Subgaleal bleed 20
Sucking reflex 21, 23, 180
Superhero posture 180
Supracondylar fracture 207
Gartland classification of 208
severely displaced 208
Supraventricular tachycardia 114–115
Swelling in single joint 190–191
Swimming reflex 180
Syncope 114
Syndactyly 25
Systemic lupus erythematosus 15, 16, 192
American College of Rheumatology diagnostic criteria for 193
T
Talipes equinovarus (club foot) 28, 28
Tanner stages 61
female 63
male 62
Telangiectasia 163
Telecanthus 307
Tendon reflexes 176, 177
Tension headache 149–150
Teratogenic drugs, and abnormalities in newborn 301, 302
Testicular torsion 129
Tetracyclines 302
Tetralogy of Fallot 112, 112–113
Thalidomide 302
Thrombocytopenic purpura 252–253
Thyroid disease 226–227, 227, 227
Thyrotoxicosis see hyperthyroidism
Tinea capitis 240, 241, 242
Tinea corporis 241, 242
Tinea cruris 242
Tinea pedis 242
Tinea versicolor 242
Tissue transglutaminase (TTG) 133
Tobacco 302
Toddler fracture 186
Tongue tie 21, 23
Tonsillitis 221–222, 222
Tonsils 235
Brodsky scale of tonsillar size 235, 236
inspection of 235
Total anomalous pulmonary venous drainage 112
Toxoplasma 304
Tracheal tug 37
Tracheostomy 228, 229
Transient synovitis 186–187
Transposition of the great arteries (TGA) 111, 112
Transverse myelitis 158
diagnostic and exclusion criteria 158
Triage notes 2
Trigeminal nerve (CN V) 169, 170
Trigonocephaly 306, 307
Trisomy 13 see Patau's syndrome
Trisomy 18 see Edwards’ syndrome
Trisomy 21 see Down's syndrome
Trochlear nerve (CN IV) 168
CN IV palsy 168
Tuberculosis (TB) 91–92, 266
in HIV positive patient 91
miliary TB 91
Tuberous sclerosis 296
Turner's syndrome 201, 284, 288–289, 291, 291
Turricephaly 306, 307
Tussive vomiting 90
U
Uhthoff's sign 159
Ulcerative colitis 128
Paediatric Ulcerative Colitis Activity Index 129
Ultrasound, abdominal 143
Umbilical hernias 27, 139, 139
Umbilical stump 27
Urethral meatus 28
Urinary tract infections (UTIs) 126–127
recurrent 127
symptoms of 127
urine dipstick and culture for 127
vesicoureteric reflux 127, 127
Urticaria 242–243, 244
V
VACTERL syndrome 30
Vagal nerve (CN X) 172–173
Valve disease, childhood 110, 110
Varicella zoster virus 247
Ventricular septal defect (VSD) 108, 108–109
Vesicobullous lesions 247
bullous impetigo 250, 251
chickenpox 247–248, 248
eczema herpeticum 248, 249
hand, foot and mouth disease 249
molluscum contagiosum 249–250
Stevens-Johnson syndrome 250, 252
Vesicoureteric reflux 127, 127
Vestibulocochlear nerve (CN VIII) 172
Viral cerebellitis 145–147
Viral gastroenteritis 132
Viral myocarditis 115
Virus-induced wheeze 88
Visual assessment 166–168
acuity 167
fundoscopy 167
light reflexes 167
responsiveness 167
visual fields 167
Vitamin A deficiency 53
Vitamin C deficiency 53
Vitamin D deficiency 53, 75, 115
Vitamin E deficiency 53
Vitamin K deficiency 53
Vomiting 129–131
causes of 130
gastro-oesophageal reflux disease 130–131
in morning 150
by norovirus 129
post-tussive 129
pyloric stenosis 131
red flags 129–130
W
Waiter's tip posture 25
Warfarin 302
Weakness 152, 152, 153
Weight, faltering, 51–53
Weight gain, poor 47–48
Weight loss
from malabsorption 128
neonatal 49–51
Wet cough 90
Wheeze 83, 87, 99
asthma 88, 89
bronchiolitis 87–88
differential diagnoses, age-dependent 87
virus-induced 88
White reflex 167
Whooping cough 91
Williams’ syndrome 271, 285–286, 293–294, 294
Wilson's disease 138
Wolff–Parkinson–White syndrome 115
X
Xanthelasma 138
X-linked syndromes 295, 297–298
Z
Zika virus 304
Zinc deficiency 53
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Chapter Notes

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