Sudden infant death syndrome physical examination: Difference between revisions

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{{Sudden infant death syndrome}}
{{Sudden infant death syndrome}}


{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{VKG}}


==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Patients with [[sudden infant death syndrome]] ([[Sudden infant death syndrome|SIDS]]) usually appear normal. In nearly 50% of the patients the physical examination is totally normal. WHile doing a physical examination on [[sudden infant death syndrome]] ([[Sudden infant death syndrome|SIDS]]) patients physicians must take care to examine any signs of obstruction of the external airways, head entrapment, or any other environmental risk factors.
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
Physical examination in 50% of the patients with [[sudden infant death syndrome]] ([[Sudden infant death syndrome|SIDS]]) is usually completely normal.
 
OR
 
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with [[sudden infant death syndrome]] ([[Sudden infant death syndrome|SIDS]]) usually appear normal.


===Vital Signs===
===Vital Signs===


*High-grade / low-grade fever
*High-grade or low-grade fever may be present in 25% of the patients with SIDS
*[[Hypothermia]] / hyperthermia may be present
*Infection may be present in 25% of the patients with SIDS
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*Look for any signs of choking or gasping of the infant
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
Apparent life-threatening events (ALTEs) are usally episodes of apnea that are associated with skin colour changes, which include the following:<ref name="FuMoon2007">{{cite journal|last1=Fu|first1=L. Y.|last2=Moon|first2=R. Y.|title=Apparent Life-threatening Events (ALTEs) and the Role of Home Monitors|journal=Pediatrics in Review|volume=28|issue=6|year=2007|pages=203–208|issn=0191-9601|doi=10.1542/pir.28-6-203}}</ref><ref name="pmid15723922">{{cite journal| author=Kiechl-Kohlendorfer U, Hof D, Peglow UP, Traweger-Ravanelli B, Kiechl S| title=Epidemiology of apparent life threatening events. | journal=Arch Dis Child | year= 2005 | volume= 90 | issue= 3 | pages= 297-300 | pmid=15723922 | doi=10.1136/adc.2004.049452 | pmc=1720328 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15723922  }}</ref><ref name="Kiechl-Kohlendorfer2005">{{cite journal|last1=Kiechl-Kohlendorfer|first1=U|title=Epidemiology of apparent life threatening events|journal=Archives of Disease in Childhood|volume=90|issue=3|year=2005|pages=297–300|issn=0003-9888|doi=10.1136/adc.2004.049452}}</ref><ref name="pmid15805360">{{cite journal| author=Brand DA, Altman RL, Purtill K, Edwards KS| title=Yield of diagnostic testing in infants who have had an apparent life-threatening event. | journal=Pediatrics | year= 2005 | volume= 115 | issue= 4 | pages= 885-93 | pmid=15805360 | doi=10.1542/peds.2004-0847 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15805360  }}</ref>
OR
 
*[[Cyanosis]]  
*[[Cyanosis]] in 50-60% of the patients may be present.
*[[Jaundice]]
* [[Pallor]]
* [[Pallor]]
* Bruises
*Erythema


<gallery widths="150px">
===HEENT===
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
* Feeding difficulties may be present in some patients
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with [[sudden infant death syndrome]] ([[Sudden infant death syndrome|SIDS]]) is usually normal.
OR
 
*[[Jugular venous distension]]
*Check for any signs of obstruction
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
 
OR
*[[Breathing difficulties]] in 50% of the patients may be present
* Asymmetric chest expansion OR decreased chest expansion
*Any signs of respiratory infections should be evaluated
*Lungs are hyporesonant OR hyperresonant
* Physicians must take care to examine any signs of obstruction of the external airway
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with SIDS may or may not be present with the following and should be evaluated:
OR
**Any signs of valvular disease
*Chest tenderness upon palpation
**Arrhythmias
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
**Cardiomyopathy signs
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope


===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
*[[Abdominal examination]] of patients with [[sudden infant death syndrome]] ([[Sudden infant death syndrome|SIDS]]) is usually normal.
OR
*[[Abdominal distension]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with [[sudden infant death syndrome]] ([[Sudden infant death syndrome|SIDS]]) is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
*[[Genitourinary system|Genitourinary]] examination of patients with [[sudden infant death syndrome]] ([[Sudden infant death syndrome|SIDS]]) is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
 
OR
*Abnormal [[Limb (anatomy)|limb]] movements in 35% of the patients in SIDS may be noted
*Patient is usually oriented to persons, place, and time
*Should look for any changes in [[muscle]] tone
* Altered mental status
*[[Seizure|Seizures]]
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
 
OR
*[[Cyanosis]] may be present in some infants with [[Sudden infant death syndrome|SIDS]]
*[[Clubbing]]  
* [[Muscle]] tone either increased or decreased in some infants with [[Sudden infant death syndrome|SIDS]]
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
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{{WH}}
{{WS}}
{{WS}}
[[Category: (name of the system)]]
[[Category: Paediatrics]]

Latest revision as of 15:27, 18 May 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Patients with sudden infant death syndrome (SIDS) usually appear normal. In nearly 50% of the patients the physical examination is totally normal. WHile doing a physical examination on sudden infant death syndrome (SIDS) patients physicians must take care to examine any signs of obstruction of the external airways, head entrapment, or any other environmental risk factors.

Physical Examination

Physical examination in 50% of the patients with sudden infant death syndrome (SIDS) is usually completely normal.

Appearance of the Patient

Vital Signs

  • High-grade or low-grade fever may be present in 25% of the patients with SIDS
  • Infection may be present in 25% of the patients with SIDS
  • Look for any signs of choking or gasping of the infant

Skin

Apparent life-threatening events (ALTEs) are usally episodes of apnea that are associated with skin colour changes, which include the following:[1][2][3][4]

HEENT

  • Feeding difficulties may be present in some patients
  • Evidence of trauma

Neck

  • Check for any signs of obstruction

Lungs

  • Breathing difficulties in 50% of the patients may be present
  • Any signs of respiratory infections should be evaluated
  • Physicians must take care to examine any signs of obstruction of the external airway

Heart

  • Cardiovascular examination of patients with SIDS may or may not be present with the following and should be evaluated:
    • Any signs of valvular disease
    • Arrhythmias
    • Cardiomyopathy signs

Abdomen

Back

Genitourinary

Neuromuscular

  • Abnormal limb movements in 35% of the patients in SIDS may be noted
  • Should look for any changes in muscle tone
  • Seizures

Extremities

  • Cyanosis may be present in some infants with SIDS
  • Muscle tone either increased or decreased in some infants with SIDS

References

  1. ↑ Fu, L. Y.; Moon, R. Y. (2007). "Apparent Life-threatening Events (ALTEs) and the Role of Home Monitors". Pediatrics in Review. 28 (6): 203–208. doi:10.1542/pir.28-6-203. ISSN 0191-9601.
  2. ↑ Kiechl-Kohlendorfer U, Hof D, Peglow UP, Traweger-Ravanelli B, Kiechl S (2005). "Epidemiology of apparent life threatening events". Arch Dis Child. 90 (3): 297–300. doi:10.1136/adc.2004.049452. PMC 1720328. PMID 15723922.
  3. ↑ Kiechl-Kohlendorfer, U (2005). "Epidemiology of apparent life threatening events". Archives of Disease in Childhood. 90 (3): 297–300. doi:10.1136/adc.2004.049452. ISSN 0003-9888.
  4. ↑ Brand DA, Altman RL, Purtill K, Edwards KS (2005). "Yield of diagnostic testing in infants who have had an apparent life-threatening event". Pediatrics. 115 (4): 885–93. doi:10.1542/peds.2004-0847. PMID 15805360.

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