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School  Physicals 2007
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  • 1. School Physicals Michelle R. Colen, MD Dept of Family Medicine, Preventive Medicine and Community Health September 2007
  • 2. School Health Record (Yellow form review)
    • Notes made on back of form (abnormal)
      • XX = notify physician and school nurse; refer for further evaluation
      • X = minor defect; observe
      • = normal
    • Pencil only
    • Please ask physician before noting abnormality
  • 3. Vision
    • Screen will be done for acuity by volunteer staff prior to or after your exam
    • Parents will be notified of visual deficit if needed
  • 4. Height/Weight
    • Done prior to your exam
    • Note if obese or malnourished appearing—BMI
    • May refer to growth charts which will be provided
      • Pink = girls
      • Blue = boys
    • Talk to them about healthy food choices
  • 5.  
  • 6. Blood Pressure
    • Junior high/middle school and older only
    • May be difficult due to sound in room
    • If an increased reading, notify physician with you
  • 7. Scalp/Lice
    • Lice (nits) stick to the hair shaft
    • Most often found postauricular and occipital regions
    • Often confused with dandruff
    • Stigma
  • 8.  
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  • 10. Eyes
    • EOM (Extraocular Muscles)
    • Note strabismus (cross-eyed)
    • May attempt funduscopic exam (don’t torture child)
    • Room will not be dark
    • Check red reflex
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  • 15. Ears
    • Looking for cerumen impaction, fluid behind TM, foreign bodies, otitis externa, otitis media
    • Tubes are common (blue, green)
    • Note if cerumen occludes TM, but not a reason for a follow up physician visit
    • Remember to use tug to help straighten EAC (more comfortable)
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  • 43. Nose
    • Avoid contact with nasal septum
      • Gently insert then direct speculum posteriorly then upwards
    • Blue, swollen turbinates associated with allergies
    • Pink/red, swollen turbinates associated with resp infection
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  • 47. Throat
    • Kids tonsils naturally look “big”/enlarged
    • Erythema exudate or possibly unilateral enlargement would be indicative of tonsillitis or pharyngitis
    • Use tongue depressors (say “aah”) & place tongue depressor on anterior 2/3 of tongue
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  • 54. Dental
    • Dental caries/cavities
      • most common chronic disease of children aged 5 to 17
        • 5 times more common than asthma (59% vs 11%)
      • untreated can lead to problems eating, speaking, and learning
    • Fewer than 1 in 5 Medicaid-covered children received at least one preventive dental service in a recent year
  • 55. Dental
    • Talk to child about dental hygiene
    • Do they have a toothbrush?
    • Have they been to a dentist?
    • Brush teeth at least twice a day
  • 56. Dental
      • Primary Teeth Eruption Chart
  • 57. Dental
      • Permanent Teeth Eruption Chart
  • 58. Dental
    • Normal Teeth
      • free from caries
      • range from white to gray or yellow
      • well positioned in the arch a
      • free from bacterial plaque deposits
      • The gingival tissue is coral-pink color.
  • 59.
        • Early childhood caries
  • 60. Early childhood caries
  • 61. Heart
    • Can be difficult to auscultate in large, busy room
    • If question abnormality, go to a quiet area
    • Do not lift shirts to expose chest (inappropriate setting)--listen on thinnest piece of clothing or can usually “feed” stethoscope
  • 62. Lungs
    • Remember to ask the child to breath through their mouth
    • If abnormality noted, consider upper airway sounds
    • If questions, ask attending to listen
  • 63. Scoliosis/Spine
    • Always check if child’s feet are lined up evenly
    • Ask student to bend at waist or “touch their toes”
    • May need to ask student to remove a sweatshirt
    • D recommendation from USPTF
      • Requested by schools on health record form
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  • 66. Skin
    • Note any rashes or unusual lesions
    • Ecchymosis, scrapes, scratches common especially on lower legs. “Grip” bruises on upper arms are questionable
    • Poison ivy & eczema are common findings
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  • 71. Lymphatics
    • Will often feel lymphatic chains on children (benign)
    • Pronounced asymmetrically or tender is considered abnormal
  • 72.  
  • 73. School Physicals: Additional Details
    • You must participate to pass
      • You can still have fun even though its required!
      • Sign in when you arrive at the school.
    • Wear professional dress, white coat, and name tag.
    • Bring your equipment with you.
      • Charge batteries prior to coming.
    • Use the hand sanitizer in btw each student.
  • 74. School Physicals: Additional Details
    • Teach the first year students.
      • Remember they were you a year ago.