Physical Exam Key Points

1. General appearance. Child's mental status with regard to level of alertness and interaction with examiner and parents can be used as a measure of the seriousness of illness. Interaction between parents and infant offers insight into their coping mechanisms. Growth measurements demonstrate adequate nutrition.

2. Vital signs. Fever suggests infection. Tachycardia may be secondary to fever, pain, volume depletion, cardiac disease, or hyperthyroidism. Bradycardia with respiratory irregularity suggests CNS dysfunction and possibly increased ICP Hypotension can be seen in sepsis and volume depletion. Hypertension may indicate pain, increased ICP, drug effect, or hyperthyroidism.

3. Head. Look for evidence of trauma pointing to subdural hemorrhage. Tense anterior fontanelle may signify increased ICP.

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