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Pediatric Examination Handout

ROUTINE PHYSICAL EXAMINATION

The minimum necessary examination in an acutely ill patient.


The object of a routine examination is to check the different bodily
systems to exclude abnormality.
In considering symptoms related to the patient's presenting
complaint a more focused and detailed examination is necessary.
In considering the general appearance, it is important to make a
rapid assessment of the degree of illness. This is not making a
diagnosis.

The physical examination:


WHAT TO DO??

General Examination:
• General appearance (does the patient look healthy, unwell or ill, well cared
for or neglected?) Intelligence and educational level Mental state
Mental and emotional state
Physical attitude
Gait
Physique
Face
Skin
Hands
Feet
Neck
—lymphatic and salivary glands
—thyroid gland
—pulsation
Breasts
Axillae
Vital signs
—Temperature
—Pulse
—Respiration
—Blood pressure
Odours
Measurements
—Anterior & posterior fontanels
—Skull Circumference
—Height (length)
—Weight
+During 1 st
month: neonatal reflexes
+ During 1 year: tests for Developmental Dysplasia of Hip DDP)
st

Hair

Texture and grooming.
-Lice
Eyes
• Simple tests of visual acuity: compare one eye against the other
Exophthalmos or enophthalmos
Ptosis
Oedema of the lids
Conjunctivae: anaemia, jaundice or inflammation Pupils: size,
equality, regularity, reaction to light, accommodation
Eye movement: nystagmus, strabismus
Ophthalmoscopic examination of the fundi and ocular chambers.

Face
Facies
Drooling
Jaw movements
Facial symmetry or asymmetry
Rash
Features of endocrine disease or hyperlipidaemia.
Features of chromosomal disease
Low set ears
Mouth and pharynx
(a torch and tongue depressor should be used)

Breath odours
• Lips: colour and eruptions
• Tongue: protrusion and appearance
• Teeth and gums (if patient has dentures, notice whether they fit and
ask whether they are worn for meals or only for cosmetic reasons)
• Buccal mucous membrane: colour and pigmentation.

Pharynx

Movement of soft palate
• State of tonsils
.

Neck
Movement,
pain and range
Veins
Lymphatic glands
Thyroid
Carotid pulses and bruits
.
Upper limbs

General examination of arms and hands
• Fingernails: clubbing or koilonychia
• Pulse: rate, rhythm, volume and character
State of arterial wall of radials and brachials
Axillae: lymph glands
Purpura
Rash
Muscles: muscle wasting, fasciculation
Tests for power, tone, reflexes and coordination
Cutaneous sensation: check all modalities to exclude root or nerve
lesions
Joints: movement, pain and swelling; rheumatiod
Rheumatiod nodules
nodules and xanthelasma at elbows.

Thorax –CHEST & HEART


Anteriorly and laterally
Type of chest, asymmetry if any
Breasts and nipples
Respiration: rate, depth and character
Pulsation
Dilated vessels
Position of trachea by palpation
Look for and palpate apex beat
Palpate over precordium for thrills
Palpate respiratory movements
Estimate tactile vocal fremitus
Percuss the lungs
Auscultate the heart sounds
Auscultate the breath sounds
Estimate vocal resonance, cervical and axillary glands.
Posteriorly (patient sitting)
Inspect and palpate respiratory movement
Estimate tactile vocal fremitus
Percuss the lung resonance
Auscultate the breath sounds
Estimate vocal resonance
Note movements and deformities of the spine
• Palpate from behind: cervical glands, thyroid
• Look for sacral oedema.

Abdomen
Inspection:
size,
distension,
symmetry
Abdominal wall: movement, scars, dilated vessels Visible peristalsis
or pulsation
Pubic hair
Hernial orifices
Palpation:
tenderness,
rigidity,
hyperaesthesia,
splashing,
masses,
liver, gallbladder,
spleen,
kidneys,
bladder
Inguinal glands
• Percussion:
masses,
liver,
spleen,
bladder
• Auscultation:
bowel sounds,
murmurs


Impulse on coughing at hernial orifices
• Inguinal glands
• Male genitalia: penis, scrotum, spermatic cord;
female genitalia: examine if relevant
• Abdominal reflexes
• Rectal examination when indicated
• Gynaecological examination when indicated
.
Lower limbs

General examination of legs and feet
Purpura
Bone deformity
Signs of rickets
• Stance, balance and gait
• Oedema of feet and ankles
• Varicose veins
• Muscles: muscle wasting, fasciculation
• Tests for power, tone, reflexes (including plantar response) and
coordination
• Joints: movement, pain and swelling
• Peripheral pulses
• Temperature of feet.

Examination of excreta
• Urine, sputum, stools, vomit: examination by naked eye, and measure or estimate
amount
• Test urine for specific gravity, sugar, protein and blood.

Summary
Schema for routine examination.
• General appearance
• Gait
• Hair
• Eyes
• Face
• Mouth and pharynx
• Neck
• Upper limbs
• Lower limbs
• Spine and joints
• Thorax
—anteriorly and laterally
—posteriorly
• Abdomen
• Examination of excreta

-Use a checklist.