Physical Examination

Always plot the weight, length, and BMI on a growth chart. You are looking for trends. Do not just look at the numbers obtained during the visit. How do they compare to the last well visit? Last well visit the weight was at the 25th percentile but this time it is at the 75th percentile….what happened?

Skin

• Observe for acne, atypical nevi, and acanthosis nigricans
• Document piercings and tattoos.
• Assess for signs of abuse or self-inclicted injury.

Spine

• Examine the back and spine for deformities, such as scoliosis.

Breast

• Perform visual inspection or palpation and assess for sexual maturity rating (SMR) on females.
• Observe for gynecomastia on males.

Genitalia

• Perform visual inspection for SMR.
• Perform pelvic examination if clinically warranted.
• Palpate testicles for SMR.
• Examine testicles for hydrocele, hernias, varicocele, or masses.