pediatric final

سمري للنورمل شنو نحجي و بالامتحان نغير حسب الفايندنغ

### 🩺 Abdominal Examination Summary (Normal Findings) > On general inspection, the patient appeared comfortable at rest with no signs of distress. There were no features of jaundice, pallor, dehydration, or cachexia. Or dysmorphic features > On abdominal inspection, the abdomen was flat and symmetrical with no distension. There were no scars, striae, dilated veins, visible masses, or visible peristalsis. The umbilicus was centrally positioned and normal. > On palpation, the abdomen was soft and non-tender in all quadrants, with no guarding or rigidity. No masses were palpable. The liver edge was not enlarged and non-tender The liver span is ( ) . The spleen and kidneys were not palpable. The abdominal aorta was centrally located and of normal width. No palpable para aortic lymph nodes > On percussion, the abdomen was predominantly tympanic with no shifting dullness. Liver span was normal and there was no evidence of splenic enlargement > On auscultation, bowel sounds were present and normal in frequency and character. No abdominal bruits were heard. . > Hernial orifices were intact with no hernias detected.

كل خطوات الابدومينل اكزام

Abdominal exam 👉 Wash hands 👉 Position patient at 45° 👉 Expose from nipples to groin 👉 Ask about pain before touching --- ## 👀 General Inspection > I will start with a general inspection of the patient. * Level of comfort or distress * Body build and nutritional status * Jaundice * Pallor * Hydration status * Presence of lines, drains, or medical devices --- ## 🔍 Inspection of the Abdomen > I will now inspect the abdomen. Look for: * Shape: flat, distended, scaphoid * Symmetry * Scars * Dilated veins * Striae * Hernias * Visible masses * Visible peristalsis * Pulsations > I will also inspect the umbilicus for any hernia, inflammation, or discharge. --- ## ✋ Palpation ### 🔹 Light Palpation > I will start with light palpation, away from any painful area. Check for: * Tenderness * Guarding * Rigidity * Superficial masses --- ### 🔹 Deep Palpation > Now deep palpation in all quadrants. Assess for: * Deep tenderness * Masses * Organ enlargement --- ### 🫀 Liver Palpation > I will palpate for the liver starting from the right iliac fossa moving upwards. Note: * Size * Edge (smooth or irregular) * Tenderness --- ### 🩸 Spleen Palpation > I will palpate for the spleen from the right iliac fossa diagonally towards the left costal margin. --- ### 🫘 Kidneys (Bimanual Palpation) > I will ballot the kidneys. --- ### 🤚 Aortic Palpation > I will palpate for the abdominal aorta and assess its width. --- ## 🥁 Percussion > I will now percuss the abdomen. * General percussion (tympanic or dull) * Liver span * Splenic dullness * Shifting dullness (ascites) --- ## 🎧 Auscultation * Bowel sounds (presence, frequency, character) * High-pitched sounds → obstruction * Absent sounds → ileus/peritonitis > I would also listen for bruits over the aorta and renal arteries. --- ## 👖 Hernial Orifices > I would examine the hernial orifices. --- ## 🍑 Rectal Examination > If indicated, I would perform a digital rectal examination. --

Liver span 5 to 6 in neonate 6 to 7 in pre school 8 to 9 in school and adolescent

Transfusion

Bone marrow

Lumber puncture

# 🚼 Urinary Catheterization (Pediatrics) Urinary catheterization = insertion of a sterile tube into the bladder via urethra to drain urine. --- ## ✅ Indications ### 🔹 Monitoring * Accurate urine output (shock, ICU, burns) * Post major surgery ### 🔹 Diagnostic * Sterile urine sample (infants) * Imaging (VCUG) * Urinary retention evaluation ### 🔹 Therapeutic * Acute urinary retention * Neurogenic bladder * Obstruction (posterior urethral valves, stones) * Bladder decompression --- ## 🚫 Contraindications Do NOT catheterize if urethral injury suspected: * Blood at urethral meatus * Pelvic fracture * Perineal bruising 👉 Risk of false passage → do suprapubic catheter --- ## 📏 Catheter Size (French) Use smallest effective size. | Age | Size | | ------------ | -------- | | Preterm | 3.5–5 Fr | | Term neonate | 5–6 Fr | | Infant | 6–8 Fr | | Toddler | 8 Fr | | School-age | 8–10 Fr | | Adolescent | 10–12 Fr | --- ## 🛠️ Types | Type | Use | | --------------------- | ------------------------------------ | | Straight catheter | In-and-out (sample) | | Foley catheter | Indwelling, balloon holds in bladder | | Suprapubic | When urethral route contraindicated | --- ## 🧰 Equipment Sterile gloves, catheter, lubricant, antiseptic, syringe (balloon), drainage bag, drapes. --- ## 👶 Positioning | Sex | Position | | ------ | ------------------ | | Female | Frog-leg | | Male | Supine, legs apart | --- ## 🚑 Procedure ### 1️⃣ Preparation * Explain to parent/child * Hand hygiene * Sterile field --- ### 2️⃣ Cleaning Female * Separate labia * Clean front → back Male * Retract foreskin (if uncircumcised) * Clean circular from meatus outward --- ### 3️⃣ Insertion Female * Insert upward & backward * When urine appears → advance 1–2 cm → inflate balloon Male * Hold penis 60–90° * Insert slowly * Advance to bifurcation → inflate balloon ⚠️ Never inflate balloon if no urine return. --- ## ✔️ Confirmation * Urine flow * No pain during balloon inflation * Able to flush --- ## 📌 Securing & Care * Secure to thigh * Bag below bladder * Closed system * Daily hygiene * Remove ASAP --- ## ⚠️ Complications ### Immediate * Trauma/bleeding * Pain * False passage ### Late * UTI (most common) * Urethral stricture * Bladder spasms * Paraphimosis --- ## 🚨 Red Flags After Insertion * No urine output * Severe pain * Blood in urine * Leakage around catheter * Fever --- ## 🧠 Key Exam Points ✔ Smallest catheter possible ✔ Sterile technique ✔ Advance before balloon inflation ✔ Replace foreskin after procedure ✔ Early removal prevents infection --- ## 💡 Memory Aid — “FOLEY” Fluid monitoring Obstruction relief Look for infection Ensure sterile technique Yank out early (remove ASAP) --- If you want, I can also give: * Neonatal catheter differences * Step-by-step OSCE answer * Catheter-associated UTI prevention bundle

Urinary catheter