Health assessment, development, defects & disorders

Question 1

Vital signs

Answer 1

● Temperature, Pulse, Respiration, Blood Pressure and Pain (TPR-BPP)
● For children 1 – 10 years old: Hypotension = <70mmHg + ( age in years x 2)

Question 2

Body measurements

Answer 2

● Weight
● Height/ Length
● Head Circumference
● Chest Circumference
● Abdominal Circumference

Compare with growth standard, highlight if
● Weight fall => 2 centile
● Weight or length <3rd centile of the

Question 3

Warnings signs to growth and development

at birth

Answer 3

Very irritable or inert; Stiff or floppy;

Cloudy or white pupil

Question 4

Warnings signs to growth and development

3 months

Answer 4

Complete head lag; Hands always fisted;
Asymmetry of lack of movement of limbs;
No visual fixation; No social response

Question 5

Warnings signs to growth and development

6 months

Answer 5

Any head lag; Moro reflex or asymmetric
tonic neck reflex persists; Poor social
response; Constant squint

Question 6

Warnings signs to growth and development

9 months

Answer 6

Hand regard persists; No tuneful babbles;
Not smiling; Not chewing; Abnormal tone;
Constant use of 1 hand only

Question 7

Warnings signs to growth and development

12 months

Answer 7

No imitating play or noises; No poking or
pincer grip; Not trying words; Not sitting
alone; Constant mouthing

Question 8

Warnings signs to growth and development

18 months

Answer 8

No understanding of use or command;
Casting and mouthing; No spontaneous
words; Not standing alone

Question 9

Warnings signs to growth and development

2 years

Answer 9

No words with meaning; Excessive
dribbling; Not walking alone; No
constructive play

Question 10

Warnings signs to growth and development

3 years

Answer 10

Echolalia jargon; No sentences; Most

words unintelligible; Very clumsy

Question 11

Warnings signs to growth and development

4 years

Answer 11

No cooperative play; Very immature
speech; Not drawing; No toilet
awareness

Question 12

Warnings signs to growth and development

5 years

Answer 12

Marked confusion of sounds, grammar

and articulation; Very clumsy hands

Question 13

Physical examination : head, face and neck

Answer 13

Inspection :
Shape and symmetry
Head control and posture
Range of motion

Palpation :
Skull for sutures
Fontanel
Depression
Swelling

Question 14

Frontal fontanel

Answer 14

• diamond shaped
• 2.5 - 4cm
• closes at 12 - 18 months

Question 15

Occipital fontanel

Answer 15

• triangular shaped
• 0.5 - 1cm
• closes at 2 months

Question 16

Abnormal of head

Answer 16

● Bulging or depressed fontanels
● Widened sutures or fontanels
● Craniosyntosis - premature fusing of the sutures
● Caput Succedaneum – edema of soft scalp in
newborn
● Cephalohematoma – hematoma between
periosteum and skull bone

Question 17

What do you examine for eyes?

Answer 17

Size : symmetry ; colour ; motility

Question 18

What is abnormal for eyes?

Answer 18

● Absent of red eye reflex

Question 19

What is vision testing?

Answer 19

● Binocularity; Visual acuity

● Peripheral Vision; Color Vision

Question 20

What are the symptoms of eyes?

Answer 20

● Amblyopia (lazy eye)
● Strabismus (misaligned eyes)
● Ptosis (dropping upper eyelid)
● Cataract

Question 21

What are the risk factors for visual problems?

Answer 21

● Low birth weight of less than
1500gm
● Needed resuscitation / oxygen at
birth
● Maternal German measles or
toxoplasmosis infections during
pregnancy

Question 22

What is the abnormal of mouth and palate?

Answer 22

• Cleft lips

Question 23

what do we inspect for mouth?

Answer 23

● Cleft Palate

● Tonsilitis

Question 24

what do we inspect for ears?

Answer 24

● Size, postion & structure
● Deafness (Drugs, maternal infection)
● Abnormal or absent of ear/canal

Question 25

what do we inspect for neck?

Answer 25

● Size and orientation of associated structures
(Trachea, Thyroid gland, Lymph nodes)
● Webbing (Tuner’s Syndrome)
● Swelling (Infection)

Question 26

what do we inspect gastrointestinal tract defects?

Answer 26

● Umblical hernia
● Inguinal hernia
● Anorectal Malformation
● Biliary Atresia

Question 27

What is the genito-urinary tract defects?

Answer 27

● Cryptorchidism (undescended
testes)
● Phimosis
● Hypospadias

Question 28

What is the physical examination of spine?

Answer 28

● Spinal column
● Symmetry of scapulae, buttocks
● Shape of curvature like letter “C” at birth,
the cervical spine gains its reverse ‘C’ by
3 months, and lumber spine at 6 months
● Tufts of hair, dimples and discoloration
along the intact spine. eg. underlying
spina bifida occulta

Question 29

Spina bifidia occulta

Answer 29

Spina bifida occulta is when a baby’s backbone (spine) does not fully form during pregnancy.

Hair tuft

Question 30

Meningocele

Answer 30

A meningocele is a birth defect where there is a sac protruding from the spinal column.

Spinal fluid

Question 31

Lipomyelomeningocele

Answer 31

A lipomyelomeningocele is a fatty mass under the skin on the child’s back.

Question 32

Myelomeningocele

Answer 32

A myelomeningocele (pronounced my-elo-men-IN-go-seal) is a defect of the backbone (spine) and spinal cord.

Spinal nerves

Question 33

What is the physical examination of spine?

Answer 33

Skeletal Defects: Scoliosis
Arises at puberty
Lateral curvature of the spine that occurs most frequently during the linear growth spurt (before
12 years old) of especially in female at the onset of early puberty

Question 34

What is the physical examination of extremities?

Answer 34

Fingers and Toes Abnormality
Inspect for symmetry in length,
size & shape bilaterally
● Polydactyly (Extra digit)
● Syndactyly (Fused digit)
● Clubbed Fingers

Question 35

What are the skeletal defects ( congenital )

Answer 35

● Dysplasia of Hip
- Dislocation of the hip joint, ball out
of socket

Question 36

Congenital Club Foot (Congenital Talipes

Equino Varus)

Answer 36

• Foot appears like a golf club (lateral or
  medial)
• Feet: Pigeon toe caused by internal
  tibial torsion, persisting after 3 months
• Gait: Toe walking persisting beyond
  infancy.

Question 37

Legs

Answer 37

Bowleg

Knockknee