PHYSICAL EXAMINATION

GENERAL SURVEY Baby is awake, comfortable, no gross malformations observed and not in cardiorespiratory distress

ANTHROPOMETRIC MEASUREMENTS AND VITAL SIGNS Head Circumference: 33 cm Chest Circumference: 29 cm Abdominal Circumference: 30 cm Length: 47 cm Weight: 1.90 kg Temperature: 38.1 oC (ear) HR: 176 bpm RR: 64 bpm Good Pulses* *sorry, the baby's arm was too small for the infant cuff we borrowed; popliteal BP was attempted but to no avail For Babies ages 0-3 months: Expected Approximate daily wt. Gain: 30 g Approximate monthly wt. Gain : 2 lbs (.91 kg) Growth in length : 3.5 cm/mo Growth in head circumference: 2.0 cm/mo Recommended daily allowance: 115 kcal/kg/day

SKIN AND NAILS Skin brown skin and pinkish palms and soles Texture: smooth and supple to touch Warm to touch (-) jaundice, central and peripheral cyanosis Nails (-) cyanosis, gross nail deformities, clubbing, inflammation Hair black color, evenly distributed, smooth to touch, (-) alopecia, infestations, infection, masses (note: fontanels unassessed)

HEAD AND NECK Face (-) gross deformities, normal facial features when crying (like wrinkling of the forehead, wide opened mouth) Eyes (+) aligned with respect to auricles, eyebrows symmetrical anicteric sclera and pink conjunctiva (-) nodules, swellings, proptosis pupils round, regular in size, central and briskly reactive to light Ears (-) external deformities, inflammation, swelling, exudates, bleeding, discharges ears symmetrical in size (note: otoscopic evaluation unperformed) Nose (-) external deformities, inflammation Nasal Mucosa (-) erythema, inflammation, exudates Nasal Septum midline

HEAD AND NECK Mouth Lips: (-) ulcers, cyanosis Buccal mucosa and gums: pink in color, (-) ulceration, pigmentation, nodularities, bleeding, no visible palate defects Teeth: Toothless Tongue: midline, normal in size and texture   Neck (-) lymphadenopathy*, tracheal deviation thyroid not palpated, no visible carotid pulsations, (-) NVE, sternocleidomastoid muscles used only when crying (not while sleeping) *Tried to palpate but, due to strict instructions not to overly tax the px, opted not to. However, while we (roel, ako and john) were watching intently, the px’s clerk did a complete physical exam and noted no lymphadenopathy and no NVE

CARDIO-RESPIRATORY SYSTEM RR 64 bpm and not in cardiorespiratory distress*, high pitch cry (normal na cry ng babies) (-) cyanosis, alar flaring, use of accessory muscles for breathing (-) subcostal and supraclavicular retraction (-) prominent rib cage and clavicles (-) gross deformities anterior and posterior, but with slight depression in midline, subxyphoid area (mother says it has always been there) Although the child was with oxygen support, it was observed that she was not having labored breathing while sleeping and there were no use of accessory muscles while the child was asleep or while resting; Note: hindi ko sure kung Harrison’s groove macoconsider

Harrison’s Groove or Not? Above: Patient with rickets presenting with Harrison’s Groove Below: Case patient? Note: di ko sure if Harrison’s Groove siya, may nakita ako sa Nelson, ito iyong picture

CARDIO-RESPIRATORY SYSTEM (-) axillary lymph node enlargement Symmetrical chest expansion, normal breath sounds, no heaves, thrills, wheezes or crackles Adynamic precordium, heart rate of 176 bpm with regular rhythm, no murmurs or rubs Good and regular pulses* *Radial, brachial and popliteal pulses

GIT AND GUT Flabby abdomen, symmetric in size and shape, umbilicus midline (-) visible masses, herniation, abnormal pulsations Hypoactive bowel sounds (0/m), no borborygmi (-) inguinal lymphadenopathy, clitoromegaly, other genital anomalies* Flabby is synonymous to flaccid, relaxed, or without tone * There were no inguinal lymph nodes palpated (as reported by the clerk while we were watching, hehe, sowi), and there were no clitoromegaly or other genital anomalies (as seen by us)

EXTREMITIES (-) rashes, abnormal skin color changes (-) swelling and edema, muscle atrophy*, deformities (-) nodularities, masses Full range of motion upon passive and active manipulation * Baby maybe wrinkled to look at, but upon palpation, the gastrocnemius was still intact; however, the gluteus muscles were not assessed