PHYSICAL
EXAMINATION
Explain how the age of
the child influences the physical examination, including the approach
to the patient, the sequence of the examination, and the specific components
of the examination.
Explain how age-appropriate behaviors, such as stranger anxiety, affect
the ability of the examiner to perform the examination, and describe
strategies to perform a successful examination.
Recognize the value of observation as an important assessment tool.
Determine when it is appropriate to perform a complete vs. a focused
physical examination.
Explain how physical exam findings have different clinical significance
depending on the age of the child.
Be able to perform and interpret the following components of the physical
examination:
Appearance
Identify signs of acute
illness in an infant, toddler and child as evidenced by skin color,
respiration, hydration, mental status, cry and social interaction.
Interpret the general appearance of the child, including size, morphologic
features, development, behaviors and interaction of the child with the
parent and examiner.
Vital
signs
Measure vital signs, demonstrating
knowledge of the appropriate blood pressure cuff size and normal variation
in temperature depending on the route of measurement (oral, rectal,
axillary or tympanic)
Identify variations in vital signs based on age of the patient and presence
of disease.
Growth (See section on Growth)
Accurately measure growth
and interpret the findings.
Recognize the usefulness of longitudinal data
Development (See section on Development)
Accurately assess development and maturity .
HEENT
Recognize the need for
careful observation of the head size and shape, symmetry, facial features,
ear size and hair whorls as part of the examination for dysmorphic features
Identify the anterior and posterior fontanels and assess them for fullness
in infants
Discuss how the red reflex is used to detect corneal opacities and intraocular
masses.
Describe how the corneal light reflection is used to identify strabismus
Assess hydration of the mucous membranes.
Assess dentition.
Describe the tympanic membrane landmarks and movement using pneumatic
otoscopy
Neck
Palpate lymph nodes, know
what anatomic areas they drain
Demonstrate maneuvers that test for nuchal rigidity
Chest
Assess the rate, pattern
and effort of breathing.
Identify normal variations of respiration and signs of respiratory distress.
Recognize grunting, nasal flaring, stridor, wheezing, crackles and asymmetric
breath sounds and be able to distinguish between inspiratory and expiratory
obstruction.
Identify transmitted upper airway sounds.
Cardiovascular
Identify the pulses in
the upper and lower extremities through palpation.
Observe and palpate precordial activity.
Assess cardiac rhythm, rate, quality of the heart sounds and murmurs
through auscultation.
Assess peripheral perfussion, using a test for capillary refill.
Abdomen
Describe the technique
for palpating the liver, spleen and kidneys, and explain how age affects
findings, espcially in the healthy newborn.
Examine the umbilical cord in newborns for number of vessels. Identify
granulation tissue and umbilical hernias.
Assess the abdomen for distention, local or rebound tenderness, and
masses through observation, auscultation, and palpation.
Determine the need for a rectal examination, and demonstrate the age-appropriate
technique.
Genitalia
Describe the difference
in appearance of male and female genitalia at different ages and developmental
stages.
Palpate the testes.
Recognize genital abnormalities in a boy, including cryptorchidism,
hypospadias, phimosis, hernias, hydrocele and testicular mass.
Recognize genital abnormalities in a girl, including signs of virilization,
imperforate hymen, labial adhesions and signs of injury.
Extremities
Examine the hips of a
newborn for congenital dysplasia using the Ortolani and Barlow maneuvers.
Discuss age-related changes in gait.
Identify age-related variations in the examination, such as tibial torsion,
genu valgus, flat feet, etc.
Recognize pathology, such as restricted or excessive joint mobility,
joint effusions, signs of trauma, and inflammation.
Back
Describe the procedure
used to screen for scoliosis.
Examine the back for midline tufts of hair, pits, sacral dimples, or
masses.
Neurologic examination
Describe the primitive
reflexes that are present at birth and how they change as the child
develops.
Assess the quality and symmetry of tone, strength and reflexes, using
age-appropriate techniques.
Assess developmental milestones.
Describe the role of observation as part of the neurological examination.
Skin
Assess turgor, perfusion,
color, pigmented lesions, and rashes through observation and palpation
Identify jaundice, petechiae, purpura, vesicles, and urticaria.
Examine the skin for common birth marks and skin conditions unique to
children
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