PHYSICAL EXAMINATION

 Children are not adults

 Co-operation?
 Our interest contradicts theirs.
 MAKING GOOD CONTACT IS PART OF YOUR SKILLS
o SMILE!!!
o Make funny noises
o Be gentle with the child and his (sometimes) annoying parents
o Converse

General appearance
- general assessment
- level of consciousness, irritability etc.
- color
- breathing effort

Vital signs- pulse, BP, Sat.

The order is most important >> least important. auscultation >> abdomen >> ears >>
mouth.

LUNGS
- Inspiration- air entrance to the lungs
 Bronchial breathing
 Ronchi
 Crackles
 Back, front, lt. vs. rt.
- expiration- length
 wheezing
 exhaled ronchi
- Percussion
- Tactile fremitus
- Egophonia

HEART
- Precordium.
- Rhythmic sounds?
- Murmurs- systolic vs. diastolic, over the heart vs. peripheral
- Friction rub?

ABDOMEN
- Auscultation first.
- Flat vs. bloated, tense vs. soft.
- Sensitivity to palpation
- Palpation findings- SOL, HSM (abnormal span vs. downward
displacement), full bladder.
Lymphadenopathy
- occipital / retro-auricular- rubella / parvovirus infection
- pre-auricular- adenovirus infection
- parinaus- oculoglandular findings. (bartonella).
- Cervical, submandibular- neck, URT infections.
- Groin
- Popliteal fossa

SKELETON- Cellulitis? Arhtiritis? Motion disturbances? Clubbing?

SKIN- rashes, hypo / hyperpigmented lesions.

NECK

EARS- earlobes texture, tenderness, retru-auricular area, tympanic membrane with

otoscope.

MOUTH- teeth, gums, buccal mucosa, tonsils, deviation of the uvula,

retropharyngeal wall.

NEUROLOGICAL EXAMINATION
- If this is the focus- start with it!
- Neonatal reflexes- sucking + rooting- up to 4W
 Grasping- up to 2-3M
 Placing + stepping- up to 3-4 M
 Tonic neck- from 1M to 6-7M
 Moro- 5-6M
 Parachute- from 1Y forever

- tonicity- horizontal lay, head lag, scarf sign etc.

*** The basic neurological examination- consciousness, tonicity, spontaneous
movement of 4 limbs, strength, rough sensation, deep tendon reflexes.