Pediatric Exam Flashcards
What are the general components of the pediatric physical exam?
- Vital Signs
- Heart
- General Appearance
- Abdomen
- Head - Genitalia
- Ears - Rectum and Anus
- Eyes - Skin
- Nose -Extremities
- Oropharynx -Structural Exam
- Neck -Neurological
- Thorax
- Lungs
What vital signs are taken for children?
- pulse
- respiratory rate
- blood pressure
- weight
- height
- BMI
- temperature
- head circumference
What is observed in general appearance?
- general condition
- psychosocial condition
- observe seated, standing and side view
- facial symmetry
- hair pattern
- facial features
- ear size
- dysmorphic features
What is done in the ear examination?
Look closely at the pinna for placement and shape. Examine the external ear canal. When inserting a speculum in to the ear canal, observe it for any abnormalities.
Use pneumatic otoscopy to examine the tympanic membranes.
What is done in the eye examination?
- Examine the conjunctiva for color and drainage.
- Look for the red reflex (retinal blastoma), have the child look at the examiner’s finger to assess eye movement. Do an ophthalmologic exam if age appropriate.
What is done in the nose examination?
Gently lift up the tip of the nose and look inside with a bright light.
Observe the nasal septum, any drainage, and be sure to see the turbinates.
Check nasal patency in newborn infants by blocking a nostril and observing the infant.
What is done in the examination of the oropharynx?
- Examine mucous membranes for hydration, look at the tongue. View the tonsils.
- Look under the tongue in older children. Examine the teeth for hygiene and repair. Make sure the hard palate is examined.
What is done in the neck examination?
- Palpate the thyroid
- Palpate lymph nodes, noting size, location, and tenderness.
- Check neck for range of motion.
What is done in the thorax examination?
- Note any asymmetry, including sternal abnormalities. Look at the nipples and assess position. Observe the clavicles for symmetry.
- Observe the anterior-posterior diameter from a side view.
What is done during the lung examination?
First, observe quiet respiration, then listen. This may need to be done as the first part of an exam in very young infants who may become fussy and noisy later.
After quiet listening, have the child take a deep breath two or three times, and listen for abnormal breath sounds.
Observe carefully for respiratory effort and pattern.
Listen at the posts (APTM)
What is done during cardiac examination and what areas do you listen to during the cardiac examination?
- patent ductus
- peripheral pulmonic stenosis
- posterior - mitral insufficiency
Auscultate for rhythm, rate, and murmurs. Don’t forget to check pulses in upper and lower extremities.
What is done during the abdominal examination?
- Examine for contour, look at the umbilicus in newborns. Note any scars, discolorations or venous distention.
- Next, listen carefully in ALL quadrants. ALWAYS LISTEN BEFORE YOU PALPATE!
- Palpate the spleen and liver. The liver edge and spleen tip may be palpable in a newborn. Note any tenderness or masses.
- Examine the flank for tenderness or masses. Kidneys may be palpable in a newborn infant.
What are the tanner stages for pubic hair?
Tanner I
no pubic hair at all (prepubertal) [typically age 10 and under]
Tanner II
small amount of long, downy hair with slight pigmentation at the base of the penis and scrotum (males) or on the labia majora (females) [10–11.5]
Tanner III
hair becomes more coarse and curly, and begins to extend laterally [11.5–13]
Tanner IV
adult-like hair quality, extending across pubis but sparing medial thighs [13–14]
Tanner V
hair extends to medial surface of the thighs [14+]
What are the tanner stages for males?
Tanner I
prepubertal (testicular volume less than 1.5 ml; small penis of 3 cm or less) [typically age 9 and under)
Tanner II
testicular volume between 1.6 and 6 ml; skin on scrotum thins, reddens and enlarges; penis length unchanged [9-11]
Tanner III
testicular volume between 6 and 12 ml; scrotum enlarges further; penis begins to lengthen to about 6 cm [11-12.5]
Tanner IV
testicular volume between 12 and 20 ml; scrotum enlarges further and darkens; penis increases in length to 10 cm and circumference [12.5-14]
Tanner V
testicular volume greater than 20 ml; adult scrotum and penis of 15 cm in length [14+]
What are the Tanner stages for female?
Tanner I
no glandular tissue; areola follows the skin contours of the chest (prepubertal) [typically age 10 and under]
Tanner II
breast bud forms, with small area of surrounding glandular tissue; areola begins to widen [10-11.5] (before 10-precocious puberty)
Tanner III
breast begins to become more elevated, and extends beyond the borders of the areola, which continues to widen but remains in contour with surrounding breast [11.5-13]
Tanner IV
increased breast size and elevation; areola and papilla form a secondary mound projecting from the contour of the surrounding breast [13-15]
Tanner V
breast reaches final adult size; areola returns to contour of the surrounding breast, with a projecting central papilla. [15+]
