Genitalia

Inspect the external genitalia. Check for ambiguous genitalia. Is diaper rash present?

The foreskin is not fully retractable until 3 years of age or later. If you do manage to retract it, be sure you return it to its original location; otherwise you may cause paraphimosis, a situation in which the retracted foreskin impedes venous drainage of the glans and results in progressive edema and pain. Diaper rash can cause balanitis, which is an acute inflammation of the glans penis. In boys who are uncircumcised, phimosis, the pathologic inability to retract the foreskin, may develop after balanitis. Observe the position of the urethral meatus.

*Tetralogy of Fallot consists of pulmonic stenosis, an overriding aorta, a ventricular septal defect, and right ventricular hypertrophy; these conditions arise from an abnormal septation of the truncus arteriosus.

Figure 24-35 Positioning of child for otoscopic examination. There are many ways to position the child in parent's lap, which provides the child with some security. The child should be upright so that the examiner can brace the child's head against the parent's chest. The parent needs to hold the child's hands so that he or she does not grab the otoscope. If necessary, the child's legs can be scissored between the parent's legs.

Figure 24-35 Positioning of child for otoscopic examination. There are many ways to position the child in parent's lap, which provides the child with some security. The child should be upright so that the examiner can brace the child's head against the parent's chest. The parent needs to hold the child's hands so that he or she does not grab the otoscope. If necessary, the child's legs can be scissored between the parent's legs.

Inspect the scrotum. Is unilateral swelling present? Enlargement may represent a hernia or a hydrocele. Inspect any mass by transillumination. Remember that hydroceles can be transillu-minated, but hernias usually cannot. Auscultate the mass. Listening to a bowel-containing hernia may reveal bowel sounds.

Palpate the testes. Are both in the scrotum? Can an undescended testicle be palpated in the inguinal canal? If not, then while the infant is lying on the examination table, press on the abdomen while trying to palpate the undescended testicle in the inguinal canal with the other hand.

In the infant girl, is a vaginal discharge present? There is commonly a whitish, often blood-tinged discharge lasting up to 1 month after birth. This is related to the placental transfer of maternal hormones.

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