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Look around the room to see if any accessories/ instruments like crutches/ wheelchairs/ glasses/ inhalers/ Sputum sample

Once the child is seated, ask if you could expose the upper body.

For lower body, you may need to ask permission from the examiner also

General examination

  • Level of consciousness- Alert/ Oriented/ cooperative
  • Decubitus (position in bed)
  • Gait
  • Built- Average/ small or large for age
  • Nutrition- Average/ undernutrition
  • Any obvious dysmorphism
  • Respiration effort- rate, rhythm, pattern, depth, laboured or not


  1. Dysmorphism
  2. Cyanosis/ Pallor
  3. Respiratory distress- nasal cannula/ nasal flaring


  1. Congestion
  2. Hypertrophied turbinate
  3. Bleeding
  4. Polyps
  5. Nasal septum – deviation


  1. Tenderness Over maxilla
  2. Heaviness on bending forwards


  1. Post nasal drip
  2. Pharyngitis signs
  3. Tonsils


  1. Fingers- Clubbing/ Koilonychia/ Pallor/ Cyanosis
  2. Hands-Pallor in the crease/ Cannulation/ Scars


  1. Trachea position- central/ deviated
  2. Scars
  3. Tracheostomy


  1. Scars on the body- Chest/ neck/ abdomen
  2. Work of breathing
  3. Scars


  1. Scoliosis
  2. Kyphosis
  3. Winging of scapula
  4. Venous prominence

Lower respiratory tract

Inspection of chest-

  1. Shape
  2. Movement
  3. Apical impulse
  4. Respiration
    • Rate
    • Rhythm
    • Type
    • Depth
    • Pattern
  5. Accessory muscle of breathing
  6. Audible wheeze/ stridor
  7. Intercostal muscles indrawing
  8. Skin
    • Pigmentation
    • Scars


  1. Temperature
  2. Tenderness over chest
  3. Position of trachea
  4. Position of apex beat
  5. Movement of chest bilaterally
  6. Vocal fremitus


  1. Percuss both sides simultaneously.
  2. The idea is to percuss at least 3 zones of bother the lungs.
  3. Upper zone, middle zone and lower zone and compare


  1. Breath sounds
  2. Adventitious sounds
    • Ronchi
    • Crepitations
  3. Pleural rub
  4. Vocal resonance

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