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Paediatric examination (Preparation (Introduce Introduce self to the…

- - - - Inspection
        Wasting: cerebral palsy, NTD, muscle disorder, polio
        Calf bulk: DMD, MD
        Contractures: hypertonia
        Fasiculation: LMN lesion
      - Tone
        Posture: hypertonic (scissoring, pronated forearms, fisting, extended legs); hypotonic (frog leg posture); abnorml posturing/extension (fluctuating tone i.e. dystonia)
        Flex/extend limb: LMN or UMN (usually pyramidal)
        Truncal tone: backward (extensor) arch = UMN EPS lesion; hypotonic in muscle disease/some CNS disease
        Head lag: hypotonia
      - Power
        Difficult in babies, Moro reflex helpful
        In young children, gait is helpful
        4y, use MRC scale for each muscle group
      - Reflexes
        Brisk: anxiety, pyramidal lesion
        Reduced: neuromuscular problem , poor technique
        Plantars unreliable in <1y
      - Co-ordination
        Finger-nose test
        Heel-toe walking, jump, hop
        Building, undo buttons, draw/copy/write
      - Sensation
        Light touch, neurotip
      - Gait
        Ask to walk on toes, heels, outside, inside of feet
        Hemiplegic
        Toe walking (pyramidal tract, pelvic girdle weaknes)
        Broad-based (normal toddlers, cerebellar, LL weakness)
        Difficulty heel walking (foot drop e.g. HMSN)