Structured physical examination from newborn to adolescent — formative SAQs

SAQ 1 — Age-adapted sequence and threat conversion (20 marks · 15 minutes)

A 9-month-old is brought with fever. The infant clings to the caregiver and has not been undressed. ^[15]

Questions

1. Outline preparation and examination sequence for the next 10 minutes, including what you leave until last and why. (8 marks) ^[15]
2. List four red-flag findings that would make you abandon the routine sequence for ABCDE. (4 marks) ^[15]
3. State how you would measure and interpret heart rate and respiratory rate in this infant. (4 marks) ^[1]
4. Tympanic membranes cannot be seen because of distress. Write one documentation line and one safety-net plan. (4 marks) ^[15]

Model answer

1. Sequence. Prepare with hand hygiene, introduction, warm setting and caregiver lap. Observe colour, interaction and work of breathing first. Count respiratory rate when as calm as possible and note conditions. Auscultate heart and lungs early. Examine the abdomen next. Fully undress for rash when feasible. Leave ears and throat until last if safe. Avoid forced restraint as the default. ^[15]

2. Red flags. Exhausting work of breathing or poor air entry; unresponsiveness or seizure; shock signs including mottling, weak pulses and prolonged CRT with altered interaction; airway threat; rapidly spreading purpura; collapse with severe dehydration. ^{[15] [4] [3]}

3. HR/RR. Count for an adequate interval; document sleep, cry and fever; interpret with age-banded evidence-based ranges and local paediatric charts; recheck outliers; do not use adult norms. ^[1]

4. Incomplete ENT. Document: “Tympanic membranes not visualised due to distress.” Plan comfort measures and timed re-examination; safety-net for worse breathing, poor intake, non-blanching rash or lethargy. ^[15]