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DU PA Ped's Phys Exm

Duke PA Pediatrics Physical Exam

Rectal temp is mandatory under age __, and ideal up to age __ 1, 3; do not routinely perform on older child (check oral, axillary, tympanic)
Blood pressures start at age __ 3
What is the normal range for body temperature 97 to 100.3
What is the normal RR in early childhood 20-40
What is the normal RR in late childhood 15-25
RR approaches adult level by __ of age 15 years
What is the average HR for ages 1-2 110 (70-150)
What is the average HR for ages 2-6 103 (68-138)
What is the average HR for ages 6-10 95 (65-125)
Where do you measure head circumference Measure over occiput and just above eyebrows
For how long do you measure head circumference Up to age 2 at each well child visit
A child with a BMI between 85th and 95th percentile are considered __ Overweight
A child with a BMI under __ percentile is considered underweight 5th
Screen visual acuity at every well exam starting at age __ 3
How do you position the ear to straighten the canal for otoscopic examination Pull up and posterior
Characteristic of murmurs that are not innocent Loud, harsh, or heard in diastole, change with provocative maneuvers
__% of neonates have an undescended testis 3
__ of undescended testis resolve by 1 year 2/3
Flat feet are normal until age __ 3
What is the least threatening and best restraining position for a child to be in during the otoscopic exam Parent’s lap (can be done supine)
How do you straighten the ear canal in a child Pull ear up and posterior
__ is more reliable sign of meningitis in children than classic meningeal signs Nuchal rigidity
__ of adolescent boys develop gynecomastia, usually resolves when wt is addressed 2/3
Up to __% of all children have heart murmurs 50; systolic, short; Grade 3 or less; loudest at LSB
Toddlers and young children have __ abdomens Protuberant
Many umbilical hernias resolve by age __ 2; common in kids (esp AA); Auscultation: metallic tinkling every 10-30 seconds
When should you do a speculum exam on a female child Only when there is a specific problem
__% of male neonates have an undescended testis 3
2/3 of undescended testes resolve in by __ 1 year
Urethral orifice appears at some point along ventral surface of glans or shaft of penis Hypospadias
Serous fluid swelling in scrotum, will transilluminate unlike a hernia Hydrocele
Enlargement of veins in the scrotum Varicocele; usually after puberty
Varicoceles, although usually benign, warrant __, as sterility could be a problem, especially if found before puberty A urology referral
When should a pediatric rectal exam be performed If intraabdominal, pelvic or rectal disease is suspected (severe constipation, stool impaction, rashes, rectal bleeding)
Genu varum (bow legs) usually self corrects by __ of age 2 years
Genu valgum (knock knees) usually self corrects by __ of age 4 years
True foot deformities do not __ with manipulation Return to neutral position
BP normal if: SBP & DBP <90th percentile for sex, age, ht; if high, measure on at least 3 separate occasions
high normal BP: average SBP and/or DBP for age, sex and height in 90-95th percentile
high BP: average SBP and/or DBP for age, sex and height ≥ 95th percentile
Measuring ht & wt wt: infant scale up to 1 yo (weigh naked, same scale each time); ht supine to 2 yo
BMI used for age: 2-21 yo
Abnormal BMI: 1st step of investigation = Remeasure
Rashes: common causes: bacterial infxn; atopic or contact dermatitis; dermatophytic infection
Normal visual acuity 1 yr: 20/200; <4 yrs: 20/40; >4 yrs: 20/30
Neck exam: kids > 1 year: exam same as adult
In kids, sinus arrhythmia is: normal
abdomen exam may palpate for TTP/rigidity while pt sitting on mom’s lap; on table, supine w/knees & hips flexed; liver & spleen tip often palpable; palpate areas of concern/complaint last
Tanner 1: breast devt Elevation of papilla only
Tanner 2: breast devt Breast buds: areola projects
Tanner 3: breast devt Enlargement of breast only
Tanner 4: breast devt Enlargement & projection of areola & papilla as secondary mound
Tanner 5: breast devt Adult breast; areola no longer projects separately from breast
Tanner 1: pubic hair devt No pubic hair
Tanner 2: pubic hair devt Straight hair along labia
Tanner 3: pubic hair devt Increased quantity, darker, present in triangle shape
Tanner 4: pubic hair devt More dense, curled and adult distribution
Tanner 5: pubic hair devt Abundant, dense to inner thigh
Boys: Tanner 1 No hair, genitalia of child
Boys: Tanner 2 Light, downy hair laterally, later dark penis and testes slightly larger
Boys: Tanner 3 Hair across pubis, testes and scrotum are further enlarged, penis larger
Boys: Tanner 4 More abundant hair with curling; glans larger/ broader, scrotum darker
Boys: Tanner 5 Testes and scrotum adult size
Created by: bwyche