GPE CHILDREN

Stature
- Short (height <3rd percentile) → Familial/constitutional, chromosomal disorder (Down syndrome, turner
syndrome), hypo/hyperthyroidism, undernutrition, achondroplasia
- Tall stature (height>97th percentile) → Familial/constitutional, Marfan syndrome

Type of facies

Mongoloid faces → Down syndrome Chipmunk/haemolytic face → Thalassemia

Cushingoid face → Cushing syndrome Cretinoid face → Hypothyroidism

-Moon face with fish mouth, prominent flushed cheeks, Thick, heavy face with dull look, thick eyebrow, thick
double chin, buffalo hump protruding tongue

Monkey face/old man/pinched face → Marasmus

ANTHROPOMETRY
 HEAD TO TOE EXAMINATION

HAIR Hypopigmented, brittle, sparse hair → Malnutrition

Alopecia → Kwashiorkor, zinc deficiency
Flag sign (Alternating bands of hypopigmented & normally pigmented hair pattern) → Kwashiorkor

HEAD Size of head

Sutures - sagittal, coronal, lambdoid, frontal

Fontanels - anterior, posterior, mastoid, sphenoidal

1) Anterior fontanelle - rhomboid shape, closed at 7-19m

Causes delayed closure Causes bulging fontanelle

A 3C HI ORT -Hydrocephalus
-Achondroplasia -Meningitis
-Congenital rubella, congenital syphilis, congenital -Increased ICP
hypothyroidism -Subdural hematoma
-Hydrocephalus -Intracranial tumor
-IUGR -Post immunization (DPT)
-Osteogenesis imperfecta
-Ricket
-Thalassemia, Trisomy 13, Trisomy 18

2) Posterior fontanelle - triangular shape, closed at 2 months → delayed: down syndrome

Craniotabes - thin, parchment-like soft paper that can be indented like ping-pong ball
● Causes: Congenital syphilis, hydrocephalus, Osteogenesis imperfecta, Ricket (SHOR)

EYES Spacing of eyes- distance between both eyes

● hypertelorism (wide spacing) → cretinism, cri-du-chat syndrome, down syndrome, noonan, turner
syndrome, thalassemia

Slanting of eyes - difference in level of inner & outer canthi of eyes

● Upward slanting of eyes → down syndrome
● Downward slanting of eyes → Cri-du-chat syndrome, noonan syndrome, Trisomy 18, Turner

Conjunctiva
● Pallor → anemia
● Bitot’s spot & xerosis (dryness) → Vit A deficiency

Sclera → icterus (jaundice)

Cornea → Kayser-Fleischer ring (golden/greyish brown ring at limbus of cornea) in Wilson disease
 Pupil → leukocoria (white eye reflex/cat’s eye reflex→ grey-white appearance on examination)
● Mature cataract, retinoblastoma, retinopathy of maturity

NOSE Flat nasal bridge → Down syndrome, thalassemia, hypothyroidism, cretinism, congenital syphilis

EARS Low set ear

-Method to look : pt stand straight, draw imaginary line from outer canthus, parallel to floor
(normal = ⅓ of pinna above this imaginary line) ||| (low set ear → pinna lies below line)

MOUTH Lips → cyanosis (blue) | cracked → iron/Vit B2 deficiency

Buccal mucosa Gum

Koplik spot → measles → bleeding : scurvy, ALL
Thrush → candida albican → hypertrophy → scurvy. AML

Tongue
Size →

Colour

Pale → anemia Bright red strawberry tongue Red, swollen beefy tongue
Scarlet fever Pellagra, vit B12 deficiency
Blue → Cyanotic heart disease

Yellow → Jaundice

Bluish red tongue →

polycythemia

Coated tongue → typhoid fever Smooth, red tongue Geographical tongue

Pernicious anemia
Fissuring of tongue → Down
syndrome

Bald tongue → pellagra,

pernicious anemia, IDA
 Palate
- High-arched → Down syndrome, Marfan syndrome, Turner syndrome
- Cleft palate + high arched → Trisomy 13

THROAT Pharynx → pooling of saliva (bulbar palsy)

Tonsils → enlarged (tonsillitis), petechiae (thrombocytopenia, rubella), white patches (candida)

NECK ● Short neck → Down syndrome

● Webbing of neck → turner syndrome, noonan syndrome
● JVP, pulsation
● Position of trachea
● Lymphadenopathy → TB

CHEST Widely spaced nipple → turner syndrome

Chest deformities
● Pectus carinatum (forward protrusion→ ricket)
● pectus excavatum (depression of lower end of sternum)

Harrison sulcus
-groove seen along the insertion of diaphragm
-d/t constant pulling of soft ribs by diaphragm → Ricket

Rachitic rosary → Ricket (vit D deficiency)

Scorbutic rosary → Vit C deficiency

GENITALIA Ambiguous genitalia

Mid arm circumference and its importance

1. Types of thermometer?
- Digital thermometers. ...
- Ear (or tympanic) thermometers. ...
- Infared thermometers. ...
- Strip-type thermometers. ...
- Mercury thermometers

2. Significance of arm span EQUAL TO HEIGHT

3. DDXfor fever with chills and rigor MALARIA, UTI, TONSILLITIS, FILARIASIS
4. Type of rash in dengue fever ISLAND OF WHITE IN RED OF SEA
5. Causes of fever with vomiting MENINGITIS, AGE, dengue, typhoid
6. Stage xerophthalmia