Manual de Diagnóstico Físico en Pediatría

1. History Taking 1
History Taking Procedure 1
History Recording 2
Pedigree Symbols 6
2. Basic Parameters 9
Temperature 9
Pulse 12
Respiratory Rate 18
Blood Pressure 21
Jugular Venous Pressure 22
3. Physical Growth Assessment 25
Length and Height 25
Weight 26
Head and Chest Circumference 29
Mid-arm Circumference 29
Skinfold Thickness 30
Age-independent Measurement 30
Body Proportion 31
4. General Physical Examination 32
Sequence of Examination 32
Examination of Head and Neck 33
Head 33
Hair 37
Neck 37
Face 43
Examination of Limbs and Genitalia 59
Upper Limb 59
Lower Limb 61
Examination of Nails 61
Genitalia 62
xvi Manual of Physical Diagnosis in Pediatrics
5. Developmental and Behavioral Assessment 63
Developmental/Behavioral History 63
Developmental Screening and Examination 65
Developmental Screening and Assessment 67
6. Dysmorphic Child 71
Congenital Anomalies 71
Obtaining the History 72
Approach to the Physical Examination 73
7. Evaluating the Newborn 74
First Examination 74
Second Examination 74
Third Examination 75
Clinical Observations 75
Physical Examination 79
Clinical Cases 86
8. Respiratory System 100
Investigations 100
Signs and Symptoms 103
Examination 114
Inspection 114
Palpation 115
Percussion 117
Auscultation 118
Clinical Cases 120
Bronchial Asthma 120
Bronchiectasis 125
Bronchiolitis 127
Empyema 129
Pneumonia 130
Tuberculosis 133
Pleural Effusion 140
Pneumothorax 142
9. Cardiovascular System 144
History 144
Investigations 144
Electrocardiography 144
Chest X-ray 146
Echocardiography and Doppler Ultrasonography 146
Arterial Blood Gas Analysis 146
Cardiac Catheterization and Angiocardiography 147
Contents xvii
Symptoms and Signs 147
Chest Pain 147
Cyanosis 149
Dyspnea 151
Examination of Cardiovascular System 153
Inspection 153
Palpation 154
Percussion 156
Auscultation 156
Clinical Cases 165
Evaluation of the Infant or Child with
Congenital Heart Disease 165
Congestive Heart Failure 168
Atrial Septal Defect 170
Patent Ductus Arteriosus 172
Sydenham’s Chorea 173
Tetralogy of Fallot 174
Ventricular Septal Defect 176
Acute Rheumatic Fever 178
Mitral Insufficiency 181
Mitral Stenosis 182
Aortic Insufficiency 183
10. Gastrointestinal System 185
Symptoms and Signs 185
Abdominal Pain 185
Abdominal Swellings 189
Constipation 193
Diarrhea 194
Hematemesis 195
Jaundice 198
Melena 201
Edema 202
Rectal Bleeding 204
Regurgitation 205
Stools—Mucus and Pus 206
Vomiting 207
General Examination 208
Inspection 208
Palpation 212
Percussion 223
Auscultation 224
Genitalia 225
Per Rectal Examination 227
xviii Manual of Physical Diagnosis in Pediatrics
Clinical Cases 227
Hepatitis 227
Fulminant Hepatic Failure 229
Cirrhosis 231
Portal Hypertension 233
11. Genitourinary System 236
Symptoms and Signs 236
Dysuria 236
Enuresis 236
Hematuria 237
Oliguria 239
Polyuria 240
Clinical Cases 242
Acute Poststreptococcal Glomerulonephritis 242
Nephrotic Syndrome 245
Urinary Tract Infection 250
12. Central Nervous System 255
Investigations 255
Soft Neurologic Signs 255
Special Diagnostic Procedures 255
Symptoms and Signs 258
Disorders of Consciousness 258
Fits and Convulsions 259
Examination 263
Retraction of Head 263
Headache 264
Speech 266
Examination of Nervous System 267
Clinical Cases 299
Acute Hemiplegia 299
Cerebral Palsy 300
Hydrocephalus 305
Meningitis 308
Meningomyelocele 312
Hemiplegia 313
Paraplegia 314
Quadriplegia 315
13. Musculoskeletal System 316
Physical Examination 316
Radiographic Assessment 317
Laboratory Studies 318
Contents xix
Symptoms and Signs 319
Examination of Spine and Joints 325
Deformities of Spine 329
Clinical Cases 331
14. Endocrinology 336
Gynecomastia 336
Short Stature 337
Tall Stature 339
Thyroid Disorder 340
Adrenal Disorders 344
Diabetes Mellitus 348
Precocious Puberty 351
Delayed Puberty 353
15. Gynecologic Assessment 355
Amenorrhea 355
Dysmenorrhea 356
Approach to the Physical Examination 356
Examining Prepubertal Girls 357
Examining Adolescent Girls 358
16. Genetics 361
Down Syndrome 361
Klinefelter Syndrome 366
Turner’s Syndrome 367
17. Hematology 370
Anemia 370
Bleeding 371
Purpura 373
Hemophilia 374
Idiopathic Thrombocytopenic Purpura 379
Iron Deficiency Anemia 382
Thalassemia 387
Leukemia 391
18. Miscellaneous Cases 396
Obesity 396
Protein-energy Malnutrition 398
Rickets 404
Scurvy 407
Failure to Thrive 409
Malaria 410
Poliomyelitis 413
xx Manual of Physical Diagnosis in Pediatrics
19. Immunization 416
Immunizing Agents 416
Commonly Used Vaccines 416
Cold Chain 423
Contraindications to Vaccination 423
20. Practical Procedures 424
Collection of Blood Samples 424
Central Venous Pressure Monitoring 428
Urine Samples 429
Cerebrospinal Fluid Sample 429
Thoracentesis 431
Pericardial Puncture 432
Paracentesis Abdominis 432
Amniocentesis 432
Chorionic Villus Sampling 433
Cardiocentesis 433
Intrauterine Transfusion 434
Fetal Scalp Blood Sampling 434
Orotracheal Intubation 435
Intraosseous Transfusion 435
Defibrillation 435
Cervical Spine Immobilization 435
21. Instruments 437
Laryngoscope 437
Endotracheal Tube 437
Ambu Bag 438
Face Mask 439
Nasal Oxygen Catheter 439
Oxygen Mask 439
Oxygen Hood 439
Tongue Depressor 440
Thermometer 440
Scalp Vein Needle 440
Intravenous Cannula 440
Three-way Connector 441
Intravenous Set 441
Lumbar Puncture Needle 441
Bone Marrow Aspiration Needle 442
Infant Feeding Tube 442
Suction Catheter 442
Umbilical Catheter 443
Simple Rubber Catheter 443
Contents xxi
Foley Catheter 443
Dilys Mucus Extractor 443
Flatus Tube 444
Tuberculin Syringe 444
Metered-dose-inhaler 444
Dry Powder Inhaler 445
Spacers 445
Nebulizer 445
22. Pharmacology 446
General Medications Used in Pharmacology 446
Drugs Used in Pediatric Anesthesia 469
23. X-rays 471
Plain Radiograph 471
Pleural Effusion 471
Pneumothorax 472
Diaphragmatic Hernia 472
Pneumonia 473
Pulmonary Tuberculosis 473
Lung Abscess 474
Emphysema 475
Bronchiectasis 475
Hyaline Membrane Disease 476
Cardiomegaly 476
Causes of Small Heart 477
Pulmonary Plethora 477
Pulmonary Oligemia 477
Fallot’s Tetralogy 477
Plain Radiograph Abdomen 478
Pharynx and Esophagus 480
Oral Contrast Examination 480
Tracheoesophageal Fistula 481
Achalasia Cardia 481
Malrotation 482
Large Bowel: Barium Enema 482
Micturating Cystourethrogram 483
Polycystic Kidney Disease 484
Anomalies of Lower Limb 485
Index 489