Strep, lower lobe pneumonia, helicobacter pylori

appendicitis, constipation, UTI, acute gastroenteritis,

abdominal mass, chronic abdominal pain

Henoch-Schonlein purpura, mesenteric adenitis, blunt abdominal trauma, mono, superior mesentary artery syndrome

appendicitis, lower lobe pneumonia, trauma, inflammatory bowel disease, mass

Abdominal masses in 

RUQ

Abdominal masses 

LUQ

hydronephrosis,

splenomegaly, splenic cyst, left renal mass (wilm's tumor), left adrenal mass (neuroblastoma)

Abdominal masses 

RLQ

Abdominal masses 

Midline Lower 

Abdominal masses

LLQ

Arm and leg extend on same side; infant is turned toward arm and leg on opposite side flex

With infant on flat surface, turn head 90 degrees on surface

Asymmetrical tonic neck

Arms extend and abduct, hands open, fingers fan out, thumb and forefinger form a C; then arms flex and adduct, knees clench hips flex eyes open, infant may cry

Support head while holding and allow head to drop down and then bring back up "a bit startled"

Finger clasps examiners thumb

with infant's head midline, touch palm of infant's hand on ulnar surface with examiners thumb

Flexion of knees and hips, foot lifts as if stepping on a table

Hold infant upright under arms over edge of table, touch dorsal surface of foot to table edge

Infant's head turns towards stimulus and mouth should open

Touch infants cheeck

Stepping like motion with alternate flexion and extension of legs

Hold infant upright under arms above exam table, palmar surface of feet should be allowed to just touch table surface

Infant's mouth opens, sucking begins; gloved finger inserted in mouth, evaluates suck reflex

gently stroking lips

Hips and buttocks curve/turn towards stimulus side

hold infant firmly and stroke along spine with fingernail from shoulder to coccyx

infant should lift head, extend spine/lower extremities 

hold infant firmly support abdomen and head, legs should extend over hand

Landau 

(Postural reflex)

infant should try to protect themselves by extending arms/legs

hold infant prone and lower infant towards flat surface slowly

Parachute 

(postural reflex)

infant will lift head and extend spine along horizontal plane

infant in prone position, arms legs extended, support with both hands over flat surface

Lateral forward

(postural reflex)

infant should extend legs and bear some weight

hold infant upright underarms over exam table, touch infant's feet to surface

Positive support

(postural reflex)

breast: prepubertal no glandular tissue, areola and nipple conforms to general chest line

pubic hair: no growth

a thicker more elastic labia minora and hymen

change from red to pink epithelium in vagina

Tanner stage 1 

female

Breast buds, small amount of glandular tissue, areola widens

Downy scarcly pigmented straight hair, especially along medial border of labia majora

physiological leukorrhea starts

Tanner stage 2

female

Large and more elevation extends beyond areolar perimeter; areola continues to enlarge but remains in contour with breast

Sparse visibly pigemented curly pubic hair on labia

onset of meses

Leukorrhea

Tanner stage 3 

Female

Breast Large and more elevation areola and papilla form a mound projecting from breast contour

(half of teens, in some cases persists into adulthood)

Pubic hair is coarse, curly, abundant but less so than an adult, not on medial thighs

onset of menses

Tanner stage 4 

female

Adult size breast variable

areola part of breast contour, nipple projecting above areola 

Pubic hair lateral spreading, triange distribution with some spread onto medial thighs

Tanner stage 5

female

Period of increased testicular volume and growth of pubic hair scrotum enlarged reddened, skin taught and thinner

testes enlarged volume 1.6-6 mls

penis unchanged from tanner stage 1 or slightly larger small amount of light downy hair along base of scrotum

Glans penis has become broader and larger, scrotum further enlarged and darker, penis increased length and circumference, abundant pubic hair not on thighs yet

testes volume 12-20 ml