General Examination of a Child (PSIII)

General Conditions (ABCDE)

Appearenace

Body Built (Growth Parameters = Anthropometric measurements)

Color

Decubitus (Patient’s Sitting & Position)  Supine, semi-sitting, sitting , prior position , squatting
position.

Dysmorphic (Congenital Abnormality, focusing on Down’s Syndrome)

Distress (any signs of respiratory distress, dyspnea- Active Ala Nasi, use of accessory muscles,
retraction of intercoastal and subcoastal muscles)

Environment (Any connections to the patient)

- Half the examination questions are answered by the mother usually.

Vital Signs

1.Sites wen can detect the pulse in:

- Apical
- Carotid
- Brachial
- Femoral
- Radial

2. RR

3. BP (in patient less than 2yo, we check the pulse at the apical site, but those older than 2yo we
have the 5 other sites to check the pulse from)

4. Temperature

- Rectal (more accurate, gold standard) (in patients less than 2yo, we measure temperature in
Rectal Region)
- Axillary ( for patients between the age of 2y -6y), (if the patient is less than 2yo and is
uncooperative, we use the axillary region to measure the temperature.)
- Oral
- Tympanic (ears)
- Temporal Artery (forehead)

Rectal

Oral (-0.5 degrees from the rectal reading)

Axillary (-1.5 degress from the rectal reading)

- Surgery, diarrhea , irritation ( contraindication for taking temperature from Rectal Region)
Anthrometric Measurements

Growth Parameers

Weight

Height / Length (use height if patient can stand, use length is patient cannot stand)

Head Circumference

- Neonate (first 4 weeks of life)

- Memorize the at birth weight, average length and average head circumference.
- The weight triples 1 year after birth, the weight doubles six months after birth.
- Use a digital scale to measure the weight. (they might bring a question wit the picture of a
digital scale and ask us to identify it, and state its use, and ask us expected weight based on
a scenario they give)
- They will give us a scenario regarding height and ask us to calculate the expected height of
the patient based on the age.
- Hapenden infantometer use requires the help of an assistant.

Occipito-frontal circumference measurement (head circumference)

- They will ask us questions on identifying this type of measurement and then ask us to
measure the age based on given information.

THE GROWTH CHARTS (weight /age)

In the growth weight chart, they will ask us questions regarding data from graph and ask us to state
the diagnosis and mention 2 causes from it.

95% percentile – quarter percentile

Prader-Willi syndrome makes the patient hungry leading to obesity and DM eventually.

THE GROWTH CHARTS (height /age)

In the growth height chart, they will ask us questions regarding data from graph and ask us to state
the diagnosis and mention 2 causes from it.

THE GROWTH CHARTS (head circumference / age)

In the growth head circumference chart, they will ask us questions regarding data from graph and
ask us to state the diagnosis and mention 2 causes from it.

- Congenital TORCH infections are the ones the neonate receives from the mother during
delivery.

Toxoplasmosis

Other (

Rubella

Cytomegalovirus

Herpes Simplex
Head to Toe Examination

Anterior Fontanelle has a diamond shape. Closes at minimum 9 months, maximum at 18 months.

Posterior Fontanelle has a triangular shape, smaller in size than Anterior Fontanelle. Closes First.

If there is a delay in closure of the anterior fontanelle, there are multiple causes:

1. Down Syndrome
2. Cretinism
3. Hydrocephalus
4. Rickets

Scenario question: the patient is 2 year old and upon examination, his anterior fontanelle is not
closed. Mention 2 possible diagnosis/causes of this delay?

EYES

Use your thumb to lower the posterior eye lids.

NOSE

Checking if there is blood or mucus discharge from the orifices.

Check for respiratory distress  Active Ala Nasi

MOUTH

- Check the mucous membrane of the lips for Jaundice, Pallor or Cyanosis.
- Check for Ulcer, Apthus ulcer occurs in Crohn’s Disease.
- Check for any focused infections in mouth cavity (Mouth Hygiene)
- Teething (delay in teething is due to Vit D deficieny, severe malnutrition)
- Ask the patient to elevate the tongue to check for Central Cyanosis.

EARS

- Discharge
- Low-set ear (Down Syndrome Patient)

They will bring a picture of an eye/sclera with jaundice infection, and then ask us to identify other
sire of Jaundice visibility and its causes.

In pallor, they will ask us the cause.

Cyanosis, are of two types. Central and Peripheral, and each has its specific sites and causes. When
mentioning the cause of Central Cyanosis, mention Congenital CYANOTIC Heart Disease, and not
simply just Congenital Heart Disease. The most common cause of Peripheral Cyanosis is exposure to
extremely cold temperatures.
Upper Extremities

NAILS

- Delayed capillary refill is mostly due to dehydration

- Koilionychia (due to trauma,)
- Leuokonychia (due to trauma , hypoproteinemia/hypoalbuminemia)
- Splinter Hemorrhage (bleeding under the nail, associated with Infective Endocarditis)

CLUBBING

- Mention the types of clubbing? Blue and Pale

- Difference between blue and pale clubbing? Blue Clubbing has cyanosis and Pale Clubbing is
considered normal.
- Mention 3 causes of clubbing?
- Mention the test? Schamroth Window Test
- Any chronic disease causes clubbing.

Palm

Lower Extremities

- Bleeding Under sking (petechiae / ecchymosis)

- Checking for edema
- Deformities  Genu Valgum (curved outwards) – Genu Varum (curved inwards)

LOWER LIMB EDEMA

- The “levels” mentioned are also prominent points for pressing and checking for edema.
- In exam if they bring a picture of edema in lower leg and ask us to identify it, mention
“Lower Limb Edema” to get the mark…and not just Edema.
- Scrotal edema in boys (genitalia)
- Vulvar edema in girls (genitalia)
- Causes of Lower Limb Edema?

Always THANK THE PATIENT…it has MARKS in the checklist. DON’T FORGET IT.