Learning the elements of a physical exam can be daunting. Pocket PEx provides a quick reference for early learners, enabling them to rapidly review the components of a regional exam, as well as the order in which the elements can be performed. There is a lot of room for flexibility and variations are common (i.e. there is not a single "best" way to do this). The key aspects are highlighted, recognizing that there are always things that might be added or removed based on the clinical circumstances.
While the exam areas are presented as "modules" (e.g. vital signs, head and neck, eye, etc), clinicians typically link together components that make the most sense for a particular situation. The final check lists (comprehensive exams) present most of the elements tied together in an organized fashion, one that allows the examiner to be efficient as they move from one skill to the next. Recognizing again that in actual practice, physicians typically add and omit sections based on the patient's presentation and their clinical judgement.
Within each section, links are provided to the Practical Guide to the Clinical Exam and a select number of other web sites, where specific maneuvers are described and/or additional relevant info provided. The interpretation of selected tests are described as well. Boxes can be checked by an observer to keep track of which elements were done.
Version 3 of PocketPex includes a few new checklists: Male genital/rectal, pelvic, breast, mental status, neck and low back exams. A number of smaller updates were also made to improve the quality of the content.
by Charlie Goldberg, MD and Derek Juang, MD; UCSD School of Medicine
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The pediatric history and exam differs from the adult evaluation in many ways. In particular, caring for children typically involves direct interaction with their parents or guardians. In addition, children usually have fewer chronic conditions, medications or past history. A significant amount of the focus is placed on anticipatory guidance (i.e. attention to risks associated with age as well as the behaviors of child and caregivers) and identifying subtle/occult developmental or physical problems. When a child presents with an acute illness, it is typically related to a single system problem.
The approach taken by a clinician must be age and situationally appropriate, with a focus on verifying normal development as well as searching for abnormalities that are epidemiologically appropriate. This includes making use of observation to determine functional abilities, enlisting the assistance of the parent to hold a toddler in their lap, and in general engaging the child in ways that wont frighten or cause undue alarm. Frequently, the order of the evaluation has to be adjusted to fit what works for the child and still accomplishes the goals of the visit.
Adjustments in history taking are made based on age and situational factors. As children age, history can be obtained w/o the parent or guardian in the room. Risk assessment guidelines (e.g. the HEADSS tool) and age appropriate milestones are provided via embedded links.
The physical exam of the newborn and infant is typically done with the child placed on an exam table
The physical exam must be age and situationally appropriate, with a focus on verifying normal development as well as searching for abnormalities that are epidemiologically appropriate. This includes making use of observation to determine functional abilities, enlisting the assistance of the parent to hold a toddler in their lap, and in general engaging the child in ways that wont frighten or cause undue alarm. that said, gaining a young child's trust and proceeding in a fashion that creates rapport and doesn't generate anxiety can be challenging!
The elements presented below cover a very complete exam. Adjustments are made based on age and situational factors. Note that frequently, the order of the evaluation has to be adjusted to fit what works for the child and still accomplishes the goals of the visit. When children move to adolesence and early adulthood, PE techniques are similar to those used w/adults.