Structured physical examination from newborn to adolescent — branching viva

Station A — Fearful toddler

Examiner: Defend your examination order for an 18-month-old who screams when you approach. [15] [1] [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] [1]

Answer: Losing cooperation prevents cardiorespiratory assessment; life threats hide in breathing and circulation, not only in the throat. [15]

Station B — Newborn hips and eyes

Examiner: The midwife felt a “hip click.” Show your reasoning. [7] [1] [1]

Strong answer: Distinguish a soft click from Ortolani clunk, Barlow dislocatability and limited abduction. A true positive Ortolani enters evaluation and referral pathways. Examine red reflexes before discharge; a white reflex is urgent. [7] [8] [10]

Probe: Can you discharge with “click, probably normal”? [7] [1] [1]

Answer: Not if manoeuvres suggest instability or screening is incomplete. Document technique and the pathway used. [7] [8]

Station C — Adolescent sensitive examination

Examiner: A 14-year-old needs abdominal and possible genital examination for pain. [16] [1] [1]

Strong answer: Private discussion; explain purpose; offer a chaperone; negotiate who stays; examine the abdomen fully first; perform intimate examination only if indicated with consent; document the chaperone discussion. [16] [17]

Station D — Bruise and synthesis

Examiner: Well 2-month-old with an unexplained trunk bruise. [11] [1] [1]

Strong answer: Full skin examination; objective notes; safeguarding pathway; pattern tools support concern for evaluation rather than a courtroom verdict; complete growth and whole-child exam for other injuries. [11]

Closing synthesis

Structured paediatric physical examination is age-adapted, observation-first when safe, technically precise for vitals and screening manoeuvres, dignity-preserving, and always ready to convert to resuscitation. Blood pressure needs correct cuff sizing when measured. Heart and respiratory rates need age-banded interpretation. [15] [1] [6] [12]