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PED Physical Exam
PED Physican Exam
| Question | Answer |
|---|---|
| Temperature | Rectal temp most accurate at any age: mandatory under age 1, ideal up to age 3. Do not check on older child! other sites: oral, axillary, typanic. Nl can range from 97-100.3 |
| BP checks usually start at age | 3. Use correct cuff size. Considered nl when systolic and diastolic <90th percentile for child's age, sex and height. |
| HBP | average SBP and/or DBP for age, sex and height ≥ 95th percentile |
| RR (infants: count for a full minute) | 20-40 early childhood, 15-25 late childhood. Approaches adult levels by age 15 years. |
| HR | radial pulses okay, brachial or femoral may be better in younger kids |
| Weight | Baby - naked, use same scale at each visit |
| Height | Measure lying down up to age 2 |
| Head circumference | Up to age 2 at each well child visit: Measure over occiput and just above eyebrowsgenetic factors influence head size |
| First step of further investigation for a high BMI: | remeasure |
| General Survey: skin, hair and nails | After first year of life exam techniques similar to adult exam, Look and feel for rashes. Common causes: bacterial infxn, atopic dermatitis, contact dermatitis, dermatophytic infxn |
| Nl BMI | between 5th and 85th percentile |
| Overweight BMI | Between 85th and 95th percentile |
| Screen visual acuity at every well exam starting at age | 3. 1yr: 20/200, <4 yrs: 20/40. >4 years: 20/30 |
| Nose inspection | inspect turbinates for bogginess and edema (other signs of allergy, inspect for patency, polyps and foreign bodies |
| Mouth and Pharynx Examination | gums, mucosal surfaces, posterior pharynx and teeth |
| nuchal rigidity | nuchal rigidity more reliable sign of meningitis in children than classic meningeal signs |
| Heart exam | sinus arrythmia nl. Murmurs are common: physiologic, up to 50% of all children, systolic, short, grade 3 of less, loudest at left sternal border |
| Diastolic murmur | something to worry about |
| Murmurs that are not innocent are | loud, harsh, or heard in diastole. associated with signs of malnourishment, associated with sx of heart failure, change with provocative maneuvers |
| Female Genitalia exam | external genital exams annually. Document tanner scales, labia majora and minora flatten, frog leg position in parent's lap or on table. Speculum exam only when specific problem |
| Male Genitalia Exam | Inspect penis (placement of urethral opening), palpate scrotum for both testes: cross legged technique (3% of neonates have an undescended teste, 2/3 resolve by 1 yr), Transilluminate scrotum if mass |
| hypospadias | urethral orifice appears at some point along ventral surface of glans or shaft of penis. |
| Hydrocele | serous fluid swelling in scrotum. will transilluminate unlike a hernia. |
| Varicocele | enlargement of veins in the scrotum. Most often found after puberty. Although usually benign, warrant a urology referral, as sterility could be a problem, especially if found before puberty |
| Rectal exam | not usually part of routine exam. Done if severe constipation, stool impaction, rashes, rectal bleeding, itching |
| bow legs | genu varum, corrects by 2 years of age |
| knock knees | genu valgum. corrects by 4 years of age. |
| age 8 is usually the age for referral if ____ has not corrected | genu valgum or varum |
| Flat feet | nl until age 3. |
| Tanner stage 1 breast | elevation of papilla only |
| Tanner stage 2 breast | breast buds, areola projects |
| Tanner Stage 3 breast | Enlargement of breasts only |
| Tanner stage 4 breast | enlargement and projection of areola and papilla as secondary mound |
| Tanner stage 5 breast | adult breast. areola no longer projects separately from breast |
Created by:
ltm12