Physical Examination

General Inspection
Name + Age + Introduction
o
o

Explain procedure
Wash Hands!

Alert/Unconscious
Dysmorphic features
Responsive/Non-responsive
Looks Well/Unwell
Comfortable/Resp distress
Pallor, cyanosis or mottling
o Confirm with SpO2 sats
Centiles
o Above or Below centiles

o Confirm with growth charts (2*age)+8

Specific for RESP
o O2 mask or prongs
o Abnormal sounds like wheeze, grunt or stridor

Cardio
Hands + Arms
o Clubbing
Splinter haemorrhages
Jane way lesions
Oslers nodes
o Pallor of palmar creases
o Pulses
30 sec
Radial-radial
Supravalvar aortic stenosis
Blalock-Taussig
Radial-femoral (coractation)
o 4 Limb BP
Coarctation of aorta
Face
o JVP (useless sign in children)
o Conjunctival pallor
o Peri-orbital oedema
Mouth (MUST use Torch)
o Central cyanosis
o Dentition
o Mucous membranes
o High arched palate
Precordium
o Central Cap Refill
o Scars
Median sternotomy

o
o

Lateral thoracotomy
Shape
Symmetry
Excavatum/Carinatum
RR + WOB
Palpate
Apex beat
Thrills
4 valvular areas
o Suprasternal notch
o RV heave
o P2
Murmur
Intensity
Timing
Nature
Radiation

Chest
o Crepitation
o Percuss for dullness
Abdo + Sacrum
o Sacral oedema
Scrotal and labial oedema in infants
o Hepatosplenomegaly
o Pulsatile liver
Legs + Feet
o Pedal and peri-tibial oedema
o Peripheral pulses
o Toe clubbing
Gastro
Hands + Arms
o Clubbing
o Leuchonychia
o Palmar erythema
o Pallor of palmar creases
o Bruising
o Pruritis marks of itching
Face
o Scleral icterus
o Conjunctival pallor
o Parotid glands
o Halitosis
o Angular stomatitis (Fe deficiency)
o Glossitis (Fe deficiency)
o Mucous membranes
o Dentition

o Tonsillar inflammation
Neck
o Lymph nodes
Chest
o Central Cap refill
o Gynaecomastia
o Spider naevi
Abdo + Sacrum
o Scars
Especially on Back
o Distension
o Caput medusa
o Pulsatile liver
FEEL
o Liver
o Spleen
o Kidneys
PERCUSS
o Liver
o Shifting dullness
SOUNDS
o Bowel sounds
o Renal bruits
Genital
o Inguinal hernia
o Scrotum
o DRE
Legs + Feet
o Per-tibial oedema
o Toe clubbing
Resp + ENT
Hands + Arms
o Clubbing
o Cap refill
o Pallor of palmar creases
o Pulses
Rate
Pulsus paradoxus
o Resp rate
o BP 4 limb
Face
o Conjunctival pallor
o Central cyanosis
o Tonsillar hypertrophy
o Cleft palate
o High arched palate

ENT
o Nasal polyps
o Ears can wait until the end of the exam
Neck
o Lymph nodes
o Tracheal deviation
Chest
o LOOK
Central Cap Refill
Scars
Medial sternotomy
Lateral thoracotomy
drain
Symmetry
Excavatum/Carinatum
Harrison Sulcus
WOB
Recession
Tracheal Tug
o FEEL
Apex beat
Chest expansion
o PERCUSS
Clavicles + into axillae
3 areas over the back
o Auscultate
Over apices
3 areas in the back
Air entry equal / reduced
Insp/Expiratory Phases
Added sounds
Heart sounds
Abdo + Sacrum
o Feel for liver edge
Hepatosplenomegaly -> Hyperexpansion of the lungs
Legs + Feet
o Toe clubbing
Investigations
Cardio
o Urine analysis -> subacute bacterial
endocarditis
o Temperature and Sats
o CXR
o ECG
Gastro

o Urine analysis
Dark urine - Bilirubin
Red urine haematuria
o Temperature and Sats
o Abdo Xray
o US
o LFTs
Resp
o Temperature and Sats
o CXR
o Sputum examination
o Spirometry
o NPA
o Lung function tests
Conclusion
This is a ______ year old child who appears
well/unwell and appropriately/over/under grown
Findings
Normal/abnormal
Absent/Present
Presentation
Name + age
who looks well with no peripheral stigmata of
cardio/resp/gastrointestinal disease and who is appropriately
grown for his/her age
There were no abnormal findings
If there abnormal findings I would do the following
investigations to confirm
Cardio
Urinalysis
Resp
Gastrointestinal