Paeds Vivas · clinical-assessment-and-reasoning
Structured physical examination from newborn to adolescent — branching viva
Branching structured oral from a toddler short-case through newborn hips and eyes, adolescent chaperone decisions, measurement technique and safeguarding bruises.
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Study tools
Target exams
Station A — Fearful toddler
Examiner: Defend your examination order for an 18-month-old who screams when you approach. [15] [1]
Strong answer: Observe first; use the caregiver’s lap; count breathing before touch if possible; auscultate early; leave ears and throat last; minimise forced restraint; document incomplete parts; convert to ABCDE if work of breathing or shock appears. [15]
Probe: Why not ENT first if parents fear tonsillitis? [15] [1]
Answer: Losing cooperation prevents cardiorespiratory assessment; life threats hide in breathing and circulation, not only in the throat. [15]
References10ShowHide
- [1]Fleming S, Thompson M, Stevens R, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet (London, England), 2011.PMID 21411136
- [6]Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics, 2017.PMID 28827377
- [7]Shaw BA, Segal LS Evaluation and Referral for Developmental Dysplasia of the Hip in Infants. Pediatrics, 2016.PMID 27940740
- [8]Singh A, Wade RG, Metcalfe D, et al. Does This Infant Have a Dislocated Hip?: The Rational Clinical Examination Systematic Review. JAMA, 2024.PMID 38619828
- [10]Donahue SP, Nixon CN Visual System Assessment in Infants, Children, and Young Adults by Pediatricians. Pediatrics, 2016.PMID 29756730
- [11]Pierce MC, Kaczor K, Lorenz DJ, et al. Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA network open, 2021.PMID 33852003
- [12]Advani N, Menahem S, Wilkinson JL The diagnosis of innocent murmurs in childhood. Cardiology in the young, 2000.PMID 10950330
- [15]Dieckmann RA, Brownstein D, Gausche-Hill M The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatric emergency care, 2010.PMID 20386420
- [16]Moon RJ, Davies JH Confidence, consent and chaperones for pubertal staging examinations: a national survey. Archives of disease in childhood, 2023.PMID 36328439
- [17]Wilson M, Patel SM, Langhan ML The Use of Medical Chaperones During Physical Examinations: The Perceptions of Adolescents and Their Caregivers. Pediatric emergency care, 2024.PMID 38032984