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