GPE scheme

DO GPE and relevant of 5 yr old child.


5 Yr old Ali is a conscious co-operative child with sallow complexion having double lumen catheter passed on left  side of neck , with an obvious circular hypopigmented scar on right side of neck and IV line passed on dorsum of right hand.
He has radial pulse rate of 90/min which is regular and good in volume.,BP of 140/90mmHg, RR of 22/min and temp of 98 degF .
His OFC is 51cm, height is 90 cm and weight is 14 KG, both height and weight appear to low for his age which i would like to plot on centile charts.
He has pallor with no jaundice ,clubbing ,koilonychia , palmer erythema, or lymphadenopathy.
examination of eyes,nose,ears and oral cavity is unremarkable except for the presence of dental caries.BCG scar is present and there is no neck swelling.There is B/L pitting pedal edema extending upto mid of tibia, there is a horizontal straight scar mark 10 cm in length extending from umbilicus towards right side , with multiple suture scar marks around this scar. the scar is hypopigmented. There is another hypopigmented circular scar measuring 0.5 by 0.5 cm ,  5 cm to the left of umibilicus,
Patient has genu valgum deformity , with intermalleolar distance of 15 cm., he is able to walk stooping forward .
Examination of back is normal , he has male type genitalia with prepubertal SMR.
On extending my examination -
(abdomen, )

gower?


every GPE should include BCG, thyroid exam, genitalia , back.
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bruise ?
macule - patch ?
scar ??  measure measure measure !!!!! --- by --- cm
lymph node  palpable? do all maeuvers of swelling, and MEASURE

suspected renal case? lower limb issues? CNS case? EXAMINE back , palpable bladder, older child look for pampers !

look of passed IVVV Line , look for scar mark of RENAL BIOPSY on back in a case OF NEPHROTIICCC or CKD ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,of SLEEEEEEEEEEEEEEEEEE !!!

CUSHING SYNDROME !!! LOOK FOR biopsy scar mark on back !!!!!!!!!!!!!!!!
(nephrotic, SLE on t/m)................(asthma case ?)

SPEED up thinking about what i have to do next after i am done doing this step !!!!!!!!!!1 (GPE or any systme exam)(SPEED UP THIS WAY)

Must not forget patient weaing GLASSES ? HEARING AID ?? PAMPERS ??
Having wheel chair by him?
foley passed/ NG passed/ iv ? central line?

watch close for petechiae, and bruise, if present, look for gingival bleed, nose ear conjunctival bleed, joint bleed, and check pampers for blood !!!!!!!!!!!!!!!!!

wATCH out for sickness status, irritability, play fullness of child.

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WHILE taking history do not say BAJI, APA, aunty... ask them what language he/she prefers. punjabi ?
DO NOT LEAD, find shortcut questions to cover up complication or systems, like chalnay phirnay ka koi masla hua tha - to cover up for any stroke like illness/ joint issues/ etc.

give 3 min initally to mother to speak !!!!!

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WHILE doing GPE, say it in your mind all positive findings that you are seeing.
So GPE finding will lead , where and WHAT you have to see more in GPE and , what in systemic examination
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