tailieunhanh - A Lange Medical Book Pediatrics on call - part 3

Âm thanh bị bóp nghẹt tim hoặc xa có thể là một đầu mối để tràn dịch màng ngoài tim như là một phần pancarditis virus hoặc do tràn dịch màng ngoài tim tự hoại. 9. Bụng. Kiểm tra thường đòi hỏi các chiến thuật diversionary. Kết quả thi, chẳng hạn như đau địa phương thường cần phải được lặp đi lặp lại | 27. FEVER 135 this will only be heard on serial exams because it may not be present at onset of fever. Muffled or distant heart sounds may be a clue to pericardial effusion as part of viral pancarditis or due to septic pericardial effusion. 9. Abdomen. Examination often requires diversionary tactics. Exam findings such as localized tenderness often need to be repeated from different approaches to validate finding. Rupture of the appendix before operative treatment is the rule in infants and young toddlers. Tenderness at McBurney point if elicited is reliable as a sign of appendicitis. Liver size as measured by distance of the edge below the right costal margin at the mid-clavicular line MCL requires knowledge of changing anatomic ratios with growth. A liver edge 3 cm below the right costal margin at the MCL may be normal in a newborn but marks hepatomegaly in a 10-year-old child. Tenderness of the costovertebral angle CVA in older toddlers and children points to a renal source of infection. 10. GU system. Perform a GU exam to evaluate for pelvic inflammatory disease in a sexually active febrile adolescent. Consider UTI in a febrile girl without other evidence of an infectious focus. Physical findings eg CVA tenderness are less reliable in younger children. Male adolescents must be assessed for testicular tenderness of epididymitis. 11. Extremities. Trauma from childhood play can be noted on the extremities and evidence of infecting cellulitis should be sought. The punctum of cat-scratch disease is most often seen on extremities upper lower as this is the site of most human contact with cats. Extremity findings can be seen in Kawasaki disease dermatomyositis SLE and vasculitic syndromes eg septic vasculitis . B. Laboratory Data 1. CBC with differential. Often overutilized in well-appearing febrile children. Total WBC is a risk factor for bacteremia in highly febrile child. Low total WBC is not a reliable predictor of meningitis because low WBC counts are seen in .