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PEDIATRIC HISTORY AND PE Contents of a Pediatric History
DR. ESTRADA/05.08.17
FINALS: QUIZ #1
HISTORY
"The mark of an excellent physician is the
proficiency with which he takes the history and
performs the physical examination and then on the
basis of the findings utilizes the laboratory accurately
and cost-effectively, when necessary, to approach a
final diagnosis and initiate effective therapy."
History taking is unique and distinctive for the following
reasons:
1. CONTENT VARIATIONS, including:
a. Prenatal and birth history
- For adults with congenital conditions, these are
also important.
b. Developmental history
c. Social history of the family (& Environmental Risks)
d. Immunization history
e. Feeding history
"These are called Content Variations because they are
always present in a pediatric history but may or may not
be present in the adult history on a case-to-case basis."
2. INDIRECT SOURCE OF CLINICAL INFORMATION
– commonly given by parents
a. Parents’ interpretation of clinical features may
affect the accuracy of the data
- Parents may have different interpretation and
may create their own diagnosis
b. Reliability of parents vary
c. Parental behaviours/emotions are important
BASIC CONCEPTS AF A GOOD CLINICAL HISTORY
 Start the interview with the parents or guardians on
a positive note (To gather the data as accurately as
possible)
 Be flexible (Children are uncooperative at times.
There is a factor of fear. So be flexible.)
 Pursue the symptoms relentlessly
 Keep “on track”
 Pursue the clinical features that enable the parents
to reach conclusions
 Keep an open mind and follow the clue
I. GENERAL DATA
“It’s not supposed to be a memory work. All of these will
have significance when you formulate your diagnosis.”
AGE – There are certain conditions which are present in a
specific age group. You can use this data to rule in or rule
out a diagnosis.
RELIGION – There are some religious groups that will not
comply with a treatment option (e.g. Blood Transfusion).
This is important in determining your management.
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 General data
 Chief complaint
 History of Present Illness
 Personal history
 Prenatal
 Natal
 Neonatal
 Feeding
 Growth and Development
 Past Illness
 Immunization
 Family history
 Socioeconomic and Environmental History
 Review of Systems
 This includes the following:
- Name, age, sex, classification, race or ethnicity,
religion, birth date, birthplace, present address,
number, and date of hospital admission
 Also include the name of the informant and his/her
relation to the patient; state the reliability of the
informant (in percentage)
o The reliability of the informant will be
reflected on the quality of data you obtain. If
there are missing data, is the informant really
reliable? The percentage reliability should be
proportional to the quality of information you
gather.
FACTORS AFFECTING % RELIABILITY: Reliability is
subjective. These are guidelines you can use to make it
objective.
 Relationship of the informant to the patient
 Number of hours the informant stays with the
patient
o Since the mother is the closest relative, she is
supposed to be the most reliable source. But if
the parents are working and the yaya takes
care of the child during daytime, the yaya
becomes more reliable.
 Educational attainment of the informant
o If the person has a higher level of education,
he is more reliable. However they can be
deceiving and manipulative.
 Involvement of the informant in the care of the
patient (Accuracy of the data gathered)
II. CHIEF COMPLAINT
 Reason why the patient is brought for consultation
 Asks “Why was the patient brought to the hospital?”
 Can be a single symptom or a group of related
symptoms
 Laboratory results can also be a chief complaint (e.g.
ABNORMAL NEWBORN SCREENING RESULT in the
absence of manifestations)
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 Should NOT include diagnostic terms or names of  Previous admission NOT RELATED TO THE HPI
diseases (Exception: FOLLOW-UP CHECK-UP e.g. are placed under Past Illnesses
Leukemia, for chemotherapy session)  If the previous admission are RELATED to the
 For OPD PATIENTS (asymptomatic patients), present illness, these should be written in the first
include: follow-up, CP clearance, well-baby care, paragraph of the HPI (e.g. in congenital conditions)
immunization  Based on the HPI, the physician should already
 Give the exact words of the informant whenever have an Initial Impression and Differential
possible* (Local dialect is discouraged because the Diagnosis.
medical report is considered a legal document.)
IV. PERSONAL HISTORY
III. HISTORY OF THE PRESENT ILLNESS (HPI)
A. Signs and symptoms should be described in A. GESTATIONAL HISTORY (PRENATAL HISTORY)
CHRONOLOGICAL ORDER, from the start of the 1. Age of mother during pregnancy
illness. 2. Parity
 Use specific number of hours/days/weeks/ 3. Health status
months prior to admission. (It is better to put the 4. Nutritional status
number of hours/days PTA rather than the specific 5. History of Past or Present Infections
date) 6. Drug Intake History
 DO NOT USE the phrases “last Monday” or “a few 7. Roentgen Exposures
weeks ago” 8. Duration of Gestation
9. etc
 For chronic illnesses: state also the date and
age at onset
B. BIRTH (NATAL) HISTORY
 If the patient is a NEWBORN and/or the present 1. AOG: Term/Premature/Postmature
problems are related to the prenatal and 2. Hours of Labor (Sepsis)
perinatal, the MATERNAL and BIRTH history 3. Manner of Delivery: NSD, LCCS (with indications)
should be incorporated in the HPI 4. Bag of Water rupture
5. Persons who attended the delivery
B. Elaborate on the Symptoms as to: 6. Birth weight
 Onset: whether acute or chronic 7. APGAR score
 Intensity of symptoms: are there any - A quick test performed on a baby at 1 AND 5
interferences in daily activities; What is the MINUTES AFTER BIRTH.
Quality? Location? Duration? Extent? Severity? - The 1-minute score determines how well the
Frequency? baby tolerated the birthing process.
 What factors aggravate or relieve the main - The 5-minute score tells the doctor how well the
symptoms? baby is doing outside the mother's womb.
 Medications - take note of the following:
1. Generic and brand names (brand names The APGAR score is based on a total score of 1 to 10.
should be written inside a parenthesis) The higher the score, the better the baby is doing after
2. Actual dose (mg/kg/day or mg/kg/dose birth. (You are trying to establish if there are resuscitative
- Check if it is within the empiric dose to know measures done during that time; but do not ask the mother
if dose is given correctly. or the informant. Rather than asking the score, take note of
the parameters.)
3. Duration of the treatment
 Describe associated symptoms as to: onset,
Interpretation:
course, chronology, and intensity
1. If the history suggests a particular disease,  A score of 7, 8, or 9 is normal and is a sign that
inquire about signs & symptoms the newborn is in good health.
characteristic of the disease  A score of 10 is very unusual, since almost all
2. Remember that pertinent negatives are of newborns lose 1 point for blue hands and feet,
value in the differential diagnosis which is normal for after birth
3. Note for other symptoms
 Re-admission: if previously admitted to this SIGN APGAR SCORE
hospital or had an OPD consultation, obtain these 0 1 2
records from the hospital and summarize them. Heart Rate Absent < 100 >100
Records of any admission to other hospitals Respiratory Absent Slow, Good cry
should also be obtained and summarized. Effort Irregular
(INTERVAL HISTORY - history of the patient from Muscle Tone Limp Some Active
the time of last admission until the present Flexion motion
admission, in relation to the same diagnosis) Reflex No Grimace Cry
Irritability Response

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Color Pale Body pink; All pink  OMIT EARLY FEEDING HISTORY UNLESS
Extremities PERTINENT to the present illness
blue  Assess:
TOTAL SCORE 1. Appetite: does the child have a good appetite or
is he/she a picky eater?
C. NEONATAL HISTORY 2. Sample diet: what does the child eat for
Note for the following: breakfast? Lunch? Dinner? Snacks? (am/pm)
 Jaundice (note the age of onset) 3. Assess if the 5 basic food groups are eaten
 Congenital abnormalities daily
 Convulsions
 Birth injury
 Hemorrhage
 Blood type
 Respiration or Feeding difficulties

The GESTATIONAL BIRTH and NEONATAL HISTORIES

should be included only in patients <2 Y/O and if
RELATED to the ILLNESS of children >2 Y/O.
- If < 2 y/o: Include prenatal and neonatal histories
- If > 2 y/o: These histories are omitted
- If present problem is related to incidents which
occurred during the prenatal, natal, and neonatal
period: include it in the HPI.

D. FEEDING HISTORY
E. GROWTH AND DEVELOPMENT HISTORY
INFANCY (<2 YEARS OLD)
YOUNG CHILDREN (1-5 YEARS OLD)
1. Type of Feeding:
a. Is the breastfeeding exclusive or mixed? 1. Development using the Modified Developmental
Checklist: Check for Motor, Adaptive/Personal,
b. How any times per day do you breastfeed?
Language, and Social
c. How long do you breastfeed with each breast?
d. If not breastfeeding, give the reason why. 2. Dental Eruption
e. What is the baby formula used? What is the 3. Other Behavioral Problems such as:
dilution and amount per day? Is it via bottle
feeding or cup feeding? a. Urinary incontinence: during day & night
b. Toilet training: when started & when completed
2. Complementary Food
c. Temper tantrums
a. Introduced at 4 months and up
d. Head banging
b. What is the consistency of the food? (Soft/
lumpy/ pureed/ table food) e. Phobias
c. What is the frequency of feeding per day? f. Pica
g. Night terrors
3. Sample Diet h. Sleep disturbances (sleeping patterns)
a. Breakfast, lunch, dinner, snacks (am/pm)
b. Assess if the 5 basic food groups (cereals/rice, NOTE: Tanner Scoring only done during this stage if there
fruits, vegetables, meat/fish/chicken, beans/egg, is precocious puberty.
milk, oil/sugar) are eaten daily
4. Compute for Actual Caloric Intake (ACI), compare MIDDLE CHILDHOOD (6-11 YEARS)
with Recommended Energy & Nutrient Intake (RENI) Inquire about the school performance and sexual
or compare both the amount and quality of food intake development using the Tanner’s Maturity Rating (TMR)
with the food guide pyramid.
5. Food intolerance
6. Multivitamins and Iron supplements: check the
dosage and frequency
7. Caregiver: Is it the mother/household help/
grandparents/siblings? (It can be a contributory factor.
Nutritional problem may boil down to the caregiver.)
CHILDHOOD TO ADOLESCENTS (2-18 YEARS OLD)

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ADOLESCENCE (12-20 YEARS)
1. Inquire about:
H – Home
E – Education
E – Eating Behavior and habits
A – Activities
D – Drugs
S – Sexual
S – Suicidal Ideations
2. Sexual development using TMR in females – include
menstrual history
F. PAST ILLNESS
(Note the age when contracted, severity, and
complications)
 Contagious diseases such as measles, varicella,
mumps, pertussis, etc.  describe the clinical course
of the illness
 Other medical illnesses: was the patient
hospitalized? Where and for how long?
 Operations: What was the surgical condition, the
type, and the place of the operation?
 Allergy, eczema, asthma, food or drug sensitivities,
etc.
 Injuries: include effects of the injuries if any; verify
the accuracy of the diagnosis by inquiring into signs,
symptoms and the course of the illness.
V. IMMUNIZATION HISTORY AND TUBERCULIN TEST
 Better if you tabulate this
 Check the types of immunizations given, including
ages when given, place where given (health center or
doctor’s clinic) and untoward reaction
 You have to know the ideal schedule of the vaccine. Do
not ask about a certain vaccine if it is not indicated for
the patient’s age.
VI. FAMILY HISTORY
 PARENTS:
- What is the state of physical and mental health
of the parents?
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- If not living – what was/were the age of death,
cause and nature of symptoms
- Was there a history of consanguinity
 SIBLINGS:
- Number, age, state of health
- If not living – note the age of death and cause
 FAMILIAL ILLNESS OR ANOMALIES:
- Contagious or genetically acquired
- This includes: TB, DM, Syphilis, CA, Epilepsy, RF,
Allergy, Hematologic Disorders, MR, Congenital
defects, etc.
o For TB, state the child’s contact with
patient
- Check for the presence of illness similar to the
patient’s illness in other members of the family
or household
- Investigate on the family pedigree if a genetic
anomaly is suspected (family pedigree is
synonymous to ancestry/family history)
VII. SOCIO-ECONOMIC AND ENVIRONMENTAL
HISTORY
 Parents: Age, occupation, & educational attainment
 Living circumstances: place and nature of dwelling;
number of persons living in the house
 Economic circumstances: members of the family
who work; source of funds (Economic status will have
an impact on your choice of management. They may
not comply with the treatment if there is a problem
with their financial status.)
 Environmental Circumstances: exposure to
cigarette smoke and other environmental pollutants
(include what pollutants and the duration of
exposure)
 Garbage disposal (do they segregate or recycle?)
 Sewage disposal
 Water source (both drinking and washing)
VIII. REVIEW OF SYSTEMS
 This is a subjective data. Do not confuse it with the PE
 Ask only symptoms applicable to the age of patient
a. General: weight loss/ gain; activity level; delay in
growth
b. Cutaneous: rash; pigmentation; hair loss; acne;
pruritus
c. Head (include eyes, ears, nose, mouth and
throat): Headache, dizziness, visual difficulties,
lacrimation, hearing difficulties, aural discharge,
otalgia, nasal discharge, epistaxis, toothache,
salivation and sore throat.
d. Cardiovascular: orthopnea; cyanosis; easy
fatigability; fainting spells
In patients with congenital conditions, there is a degree
of easy fatigability but you have to qualify it. Correlate
it with the activity (e.g. easy fatigability after feeding)
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e. Respiratory: chest pain; cough; difficulty
breathing
f. Gastrointestinal: vomiting; bowel movements -
passage of diarrhea; constipation; encopresis
(involuntary defecation associated with
emotional or psychiatric disturbance); passage of
worms; abdominal pain; jaundice; food
intolerance; pica
g. Endocrine: breast asymmetry; pain or
discharge; palpitations; cold/heat intolerance;
polyuria; polydipsia; polyphagia
h. Nervous/behavioral: tremors; sleep problems;
convulsions; weakness or paralysis; mental
deteriorations; personality or behavioral
changes; memory loss; eating problems; school
failures; mood changes temper outbursts;
hallucinations
i. Genitourinary: color of urine; burning
sensation; frequency; discharge; enuresis
(involuntary urination, esp. by children at night);
swelling of hands and feet
- PREPUBERTAL FEMALE: discharge or itching
- PUBERTAL AND ADOLESCENT FEMALE: get
the history of menstrual periods (their onset,
frequency, regularity, pain); note LMP
j. Musculoskeletal: pain in bone, joint or muscle;
swelling in bone, joint or muscle; limitation of
motion; stiffness; limping
k. Hematopoietic: pallor; bleeding manifestations;
easy bruising
PHYSICAL EXAMINATION
- Make use of playful interaction and distractions
- Minimum clothing
- Can be carried by their caretaker or parent
- For uncooperative patients: properly immobilized
- The more unpleasant or uncomfortable parts of the
PE are done last
- PARTS:
1. General Survey 6. Chest & Lungs
2. VS 7. Heart
3. Anthrop measurements 8. Abdomen
4. Skin 9. Genitalia
5. HEENT 10. Anus
11. Extremities
I. GENERAL SURVEY
 Mental state of sensorium, level of activity
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 BMI = Wt in Kg / (Lt or Ht in meters) squared
 Wt, Lt, BMI, HC: plotted on the WHO growth
chart and their percentiles and z-scores
(standard deviation scores) determined for
3 MAJOR GROWTH
nutritional PARAMETERS
assessment.
1. Weight (wt) Kg:
 Wasting and overweight
- Infant weighing
- (0-5scale:
y/o): Z< score
2y/o on Wt for Lt/Ht charts
- If patient is-able to stand upright,
(0-19 y/o): BMI z-scoreyou can use the
chart
standard weighing scale.
 Stunting (0-19) Z-scores on Lt/Ht for age charts
2. Length (Lt) (<2y/o) or Height (Ht) (>2y/o) in cm
- < 2 y/o: Length
- > 2 y/o: Height
3. Head Circumference (HC) (< 3y/o) in cm:
- supraorbital ridge to occipital prominence
 Presence of cardiopulmonary distress
 Ambulatory or bedridden
 Nutritional state (well, under, or overnourished)
 State of hydration
 Ill-looking
II. VITAL SIGNS
 There is no absolute reference range. They will vary
depending on the age bracket.
 Temperature (C)
 Cardiac Rate (CR)/ Pulse Rate (PR)
 Respiratory Rate (RR)
 Blood Pressure (BP) if >3y/o
 Lower (L) segment of the body:
- 0-3 y/o: supine, from umbilicus to tip of toes
with feet flexed 90 deg. at heel
- > 3 y/o: standing, from ASIS to the floor
 Upper (U) segment: Lt or Ht – L segment
III. ANTHROPOMETRIC DATA
 Other measurements for special circumstances:
1. Chest Circumference (CC) in cm
- Mid-inspiration
- Xiphoid notch
2. Abdominal Circumference (AC) in cm
- Infants: Supine, across the umbilicus
- Older Children: Upright, feet 25-30 cm apart,
midway between the inferior margin of the last rib
and the crest of the ilium
- Nearest 0.1 cm at the end of normal expiration
3. Arm Span & U/L ratio for children with growth
disorders:
- tip of the right to the tip of the left middle finger
Normal Values for U/L Ratio:
At Birth 1.7
1 mo. – 3 y/o 1.3
>3 y/o 1.0
 Wt for Age: used to assess whether a child is
underweight or severely underweight
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- A child can be underweight due to short Lt / Ht or
thinness or both
- Presence of edema: severely undernourished
- Plot to nearest 0.1
 Lt or Ht for Age: identify children who are stunted
or short due to chronic malnutrition or repeated
illness or those who are tall for age due to genetic or
endocrine problems.
- Plot as precisely as possible
 BMI for Age: useful in screening for overweight or
obesity
- Similar results with Wt for Lt or Ht
- Plot to nearest decimal
IV. SKIN
 Color, tissue turgor (wrinkling or loss of elasticity),
loss of subcutaneous tissue, rash or eruptions,
hemorrhages, scars, edema, jaundice
 If the patient has rashes on his extremities, include the
rash under the “skin” and omit it from the “extremities”
to avoid redundancy.
V. HEENT
 HEAD: hair (quantity, color, texture, strength, surface
characteristics); shape or contour, scalp, fontanels,
sutures; Auscultate the skull for bruits to detect AV
malformation; (normal in <4 y/o with fever); face:
unusual facies, deformities
 EYES: Lids, conjunctivae, sclerae, opacities,
discharge, red-orange reflex, periorbital edema,
eyeballs (sunken or not), tears
 EARS AND MASTOIDS: Size, shape, location and
position of the ear in relation to the rest of the head,
ear discharge, tympanic membrane, ear canal
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- Newborns & Infants: UPWARD
- Older Children: FORWARD & DOWNWARD
- Tympanic Membrane: continuity (intact or
perforated); color (light pink or translucent);
cone of light, bulging or concave; presence of
effusions or bubbles, mobility
 NOSE & PARANASAL SINUSES: patency of nares, alar
flaring, presence and character of discharge, position
of septum, sinus tenderness
 MOUTH & THROAT: Lips, gums, tongue, mucous
membranes, dentition, palate, posterior pharyngeal
wall
- Lips: Color (pale, cyanotic, cherry red), moisture
or dryness, excoriations, cleft
- Gums: Color, continuity (ulcers, vesicles),
bleeding
- Tongue: Size, moisture, color, milky white
coatings, geographic tongue, ankyloglossia
(tongue-tie), ulcers
- Dentition: 20 milk teeth at 12 mos of age, color,
mottling, pitting of enamel (fluorosis), ulcers
- Oropharyngeal mucosa: thrush, vesicles, ulcers,
enanthems
- Palate and uvula area: symmetry, cleft, high-
arched
- Throat exam: use a bright light; patient says
“Aaaahh”
- Posterior pharyngeal area: post nasal
drippings
- Excessive drooling: not usual after 18 mos. age
- Tonsils: Presence or absence , size, surface,
color, exudates, adherent membrane
- Color of oral mucosa: pinkish-red; compare
with color of tonsils.
 NECK: Venous Engorgement, flexibility, rigidity,
masses, lymph nodes, abnormal enlargement of the
thyroid glands
- Masses: Location, size, rate of growth, shape,
margin, surface, consistency, color, warmth,
pulsation, adhesion to surrounding structures;
goiter
VI. CHEST AND LUNGS
A. INSPECTION:
 Size & shape: Round/Barrel, Shield shape, Pectus
Excavatum, Pigeon chest, Rachitic Rosary, Harrison’s
groove
- INFANCY: AP diameter = Transverse diameter
- AFTER 2 Y/O: Transverse > AP Diameter
 Movement with respirations
- Newborns & young infants: ABDOMINAL
- After 4-5 years of age: INTERCOSTAL
 Chest retractions: Subcostal, Intercostals,
Supraclavicular
 Chest Expansion: Symmetry
B. PALPATION:
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 Vocal Fremitus: “tres, tres”, “ninety nine”; increased
(consolidation) or decreased (atelectasis,
pneumothorax, pleural effusion) VIII. ABDOMEN: 9 or 4 QUADRANTS
You may opt to divide the abdomen into 4 or 9 quadrants.
C. PERCUSSION: The significance of this is to be able to localize what organ/s
 DIRECT: with One Finger found in these areas, so that depending on the complain of
 INDIRECT: use two fingers: Pleximeter and plexor the patient, you may be able to consider what organ is
 Tap from side to side, top to bottom symmetrically affected.

D. AUSCULTATION: Stethoscope on bare skin A. INSPECTION:

 Clear breath sounds, rales, wheezes, rhonchi,
bronchial or tubular breath sounds, pleural friction
rub, stridor, grunting
 Normal breath sounds:
1) Bronchial: Midline
2) Vesicular: Over the chest, axilla, infrascapular area
3) Bronchovesicular: infants with thin walls
 Abnormal or adventitious sounds
 Altered voice sounds in lobar pneumonia:
- Bronchophony: Spoken words are louder &
clearer when normally, they are muffled and
indistinct
- Egophony: Spoken “ee” is hear as “ay”
- Whispered pectoriloquy: whispered words are
heard louder and clearer when normally they are
faint and indistinct or not heard at all.
 Size & shape: flat, globular, protuberant, distened,
scaphoid
 Prominent vessels: distended veins, pulsations
 Striae, peristaltic movements, umbilical hernia
 Movements in relation to respiration: paradoxical
breathing
B. AUSCULTATION:
 Done prior to palpation and percussion
 Listening to one spot is usually sufficient
 Bowel sounds: gurgling;
- 5-10 seconds intervals or longer
- 10-30 secs in infants & younger
- 5-34/min.
 Borborygmi: prolonged gurgles or hyperperistalsis
 If absent, auscultate for at least 1-2 mins.

VII. HEART AND VASCULAR SYSTEM C. PERCUSSION:

A. INSPECTION:  Normally tympanitic
 Precordium: adynamic or dynamic  Detect presence of fluid in the peritoneal cavity: fluid
 Visible pulsations on the chest and in the epigastrium wave & shifting dullness
 Apex beat: 4th ICS, LMCL until 7 y/o then shifts to  Determine the size of the liver: RMCL, scratch test
the 5th ICS
D. PALPATION:
B. PALPATION:  Patient lies supine with both lower extremities semi-
 Thrills: purring vibratory sensations felt by the palm flexed at the knees and hips
 Substernal thrust: presence of right ventricular  Ask patient to inhale slowly & deeply
volume or pressure overload  Use flat surface of the fingers
 Character of pulses  Palpate away from the site of pain proceeding gently
to the painful area (DIRECT & REBOUND
C. AUSCULTATION: Tenderness)
 (S1): closure of AV valves (tricuspid & mitral); best  Spleen: not palpable unless 2-3x its size; short’s
heard: apex maneuver; castell’s method (percussion in the 8th or
 (S2): closure of Semilunar valves (aortic & 9th ICS: RESONANT is normal. DULL is splenomegaly)
pulmonic); best heard at the left & right sternal  Psoas sign; obturator sign
borders; split on inspiration  Kidneys: best felt on deep inspiration; fixed
 (S3): gallop; best heard at the apex in mid-diastole,  COSTOVERTEBRAL ANGLE (CVA) TENDERNESS:
heart failure done only in older children and adolescents; heel of a
 Murmurs: closed fist (ulnar side) strikes firmly on the CVA
- TILT: (Timing, Intensity, Location, (angle between the 12th rib and transverse process
Transmission) of the upper lumbar vertebrae)
- Grading of murmurs:
I. Barely Audible IX. INGUINAL REGIONS
II. Medium Intensity  Hydrocoele, undescended testes, lymph nodes
III. Loud but no thrill  Fluctuation in size in relation to coughing and crying;
IV. Louder with thrill spontaneously resolves or not.
V. Loud & audible with stethoscope barely on the  Indirect inguinal hernia: most common swelling in
chest the inguinal area extending to the scrotum; males
VI. Audible with the stethoscope off the chest

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X. GENITALIA
A. MALE:
 Prepuce should be easily retractable
> PHIMOSIS
 Urethra opens at the tip of the penis
> HYPOSPADIA – meatus under surface of urethra
> EPISPADIA – dorsal surface of the penis
 Left scrotum lower than the right but equal in size
> CRYPTORCHIDISM, HYDROCOELE, HERNIA

B. FEMALE:
 Gynecological exam: discharge, laceration, hymen
 Sexual maturity testing

XI. ANUS AND RECTUM

 Left Lateral Decubitus with legs flexed against the
abdomen
 Look for location, patency, fissures, tags,
hemorrhoids, presence of pinworms, prolapse
 Rectal exam: Assess sphincteric tone, presence of
mass or impacted feces and tenderness

XII. EXTREMITIES
 Color of nailbeds, peripheral pulses
 Cyanosis, edema, mobility of joints, deformities, test
for congenital hip dislocation (neonates)
 Clubbing: look from the side in profile; Schamroth’s
sign
 Lymph nodes

XIII. SPINE

 Inspect for deformities, sacrococcygeal dimple,

pilonidal sinus and local tenderness
 Screen for scoliosis: bend forward test

XIV. LYMPH NODES

 Check size, number, location, consistency,
tenderness, mobility, discrete, matted
 Most not palpable in the newborn
 Not considered enlarged unless they exceed 1 cm for
cervical and axillary nodes and > 1.5 cm for inguinal
nodes

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TRANSCRIBERS: COMPELIO, K., LANGPUYAS, I. & PASCUA, A. Page 8 of 8