55 Questions
How many groups should students form when examining children?
2
What guidelines should students use during the examination?
Written guidelines for examination
Which is not listed as an age category for physical examination?
Adult
What is one of the specific techniques similar to adult examinations?
Inspection
Which approach differs when examining children compared to adults?
Order of examination
What are Ortolani's and Barlow's signs used to assess?
Hips
Which musculoskeletal detail is assessed for deformity, symmetry, edema, and clubbing?
Extremities
What should be avoided when assessing hernias in the genito urinary tract?
Poking a finger into the inguinal canal
What condition is frequently seen under 2 years of age and will spontaneously resolve?
Bow legs
Which of the following details is NOT assessed in the musculoskeletal system?
Cryptorchidism
Most cases of which condition will spontaneously descend by several months of life?
Cryptorchidism
What should be examined to check for a high arched condition?
Palate/Uvula
What is not assessed when examining visual acuity?
Sclera
Which of the following describes a normal characteristic of the tympanic membrane (TM)?
Opalescent color
Which part of the ear is associated with the position of the pinna?
Outer ear
What should be evaluated to detect caries?
Dentition
What is one tip to help keep a child calm during a pediatric physical exam?
Be friendly
What should be avoided to ensure a more comfortable pediatric exam?
Placing all the instruments prominently in front of the child
What is suggested when examining a child who is between 6 months and 2 years old?
Have the child sit on the mother's lap if possible
What is a key to success in a pediatric physical exam?
Patience
Why is it helpful to show the child what you plan to do during the exam?
It reduces misunderstanding and fear
What is the typical respiratory rate for a school-age child (6-12 years)?
18-25 breaths per minute
Which age group has a heart rate range of 60-100 beats per minute?
Adolescent (12-18 years)
Which of the following is NOT a cardinal principle of physical examination?
Vaccination
What is the heart rate range for toddlers (1-3 years)?
90-150 beats per minute
What is the correct respiratory rate range for an infant (birth-1 year)?
30-60 breaths per minute
What is indicated by a short neck in infancy?
Congenital abnormality
Which finding is associated with meningitis involving the neck?
Nuchal rigidity
Which condition is NOT a common feature examined in the spine?
Carotid bruits
What characteristic is used to describe lymph nodes in a physical examination?
Erythematous
What should be screened for at all ages, especially before puberty?
Scoliosis
What should always be prominently displayed by healthcare workers in the hospital?
Their name badge
Before examining a child, whose permission should be sought?
Senior nursing staff, parents, and the child if old enough
What should take precedence over any personal learning objective during a child's examination?
The well-being of the child
In what order should the examination be conducted?
Least distressing to most distressing
What is important to maintain when communicating with the child during an examination?
Honesty, especially if something will hurt
How can understanding developmental stages impact the clinical examination?
It helps anticipate the child's response, such as stranger anxiety.
At what age should an infant be measured standing instead of supine?
2 years
Which parameter is not listed under Vital Signs?
Skin color
Which measurement is recorded with percentiles on a chart?
Height, Weight, and Head Circumference
Which anatomical area is not included in the Physical Examination list?
Spine
Which factor affects both pulse and respiratory rate?
Age
What is measured in kilograms for growth parameters?
Weight
Which skin condition is described by cyanosis?
Colour
What term describes a head shape with an abnormally long and narrow shape?
Dolichocephaly
At what age should head circumference be plotted on a growth chart according to the parameters provided?
More than 2 years
Which of the following is NOT a type of head shape mentioned in the list?
Hydrocephaly
Which of the following is NOT a cardinal principle of physical examination?
Imaging
What is the term for the condition where the distance between the caruncles is greater than the length of an eye?
Hypertelorism
What is indicated by a cranial perimeter at birth that is smaller than 34 cm minus 2 standard deviations?
Microcephaly
Which anatomical feature is used to describe the term 'philtrum pillars'?
Mouth
What does an upward slanting palpebral fissure with an angle greater than 10° indicate?
Upward slanting
What is NOT included under the inspection aspects of physical examination?
Palpation
Where does the external auditory canal belong anatomically?
Ear
What is the correct description for retrognatism?
Receding mandible
Study Notes
Musculoskeletal Assessment
- Gait, symmetry, bulk and tone, strength, range of motion, dyskinetic movements, joint mechanics, and joint swellings and noise are important aspects to evaluate.
Musculoskeletal Details
Back
- Sacral dimple, kyphosis, lordosis, or scoliosis should be checked.
Joints
- Evaluate motion, stability, swelling, and tenderness.
Muscles
- Assess muscle development and tone.
Extremities
- Look for deformity, symmetry, edema, and clubbing.
Gait
- Evaluate in-toeing, out-toeing, bow legs, knock knees, and limping.
Hips
- Perform Ortolani's and Barlow's signs.
Genito Urinary Tract Assessment
External Genitalia
- Inspect external genitalia.
Hernias and Hydrocoeles
- Check for indirect hernias and gently palpate without poking the inguinal canal.
Cryptorchidism
- Distinguish from hyper-retractile testis and note that most cases resolve spontaneously by several months of life.
Tanner Staging
- Use Tanner staging handouts for adolescents.
Rectal and Pelvic Exam
- Only perform when indicated.
Physical Examination
- Examine in groups of 2 using written guidelines.
- Prioritize examination, especially for children who may go home quickly.
Physical Examination Techniques
- Use techniques similar to adults: inspection, palpation, percussion, and auscultation.
- Approach and order may differ.
Eyes
- Evaluate symmetry, swelling, lesions, discoloration, lids, epicanthic folds, sclera, pupils, visual acuity, and direct and consensual reflexes.
Ears
- Assess position of the pinna, EAC exam, TM exam, and landmarks like the malleus handle.
Oropharynx
- Evaluate dentition, mucous membranes, enanthems, tongue, palate/uvula, tonsils, and posterior pharynx.
Tips for a Successful Paediatric Physical Exam
- Be friendly, prepared, and patient.
- Use games, distractions, and explanations to comfort the child.
- Be gentle, respectful, and honest.
Be Observant and Make the Best of Unexpected Opportunities
- Position the child appropriately for the examination.
Physical Examination
- Follow the cardinal principles: inspection, palpation, percussion, and auscultation.
Pediatric Respiratory and Heart Rates
- Know the normal respiratory rates for different ages:
- Infant (birth-1 year): 30-60 breaths/minute
- Toddler (1-3 years): 24-40 breaths/minute
- Preschooler (3-6 years): 22-34 breaths/minute
- School-age (6-12 years): 18-25 breaths/minute
- Adolescent (12-18 years): 12-16 breaths/minute
- Know the normal heart rates for different ages:
- Infant (birth-1 year): 100-160 beats/minute
- Toddler (1-3 years): 90-150 beats/minute
- Preschooler (3-6 years): 80-140 beats/minute
- School-age (6-12 years): 70-120 beats/minute
- Adolescent (12-18 years): 60-100 beats/minute
Test your knowledge on musculoskeletal assessment, including gait, symmetry, joint mechanics, and more. Evaluate your understanding of back, joints, muscles, and extremities.
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