1 - History Taking and Communications with the Child Flashcards

1
Q

How do adults differ to children in medicine?

A
  • Different fluid requirements
  • Different drug doses
  • Different observations
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2
Q

How much fluid do children require in a day?

A
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3
Q

What points do you need to cover in the history taking of a child?

https://geekymedics.com/wp-content/uploads/2020/10/OSCE-Checklist-Paediatric-History-Taking-.pdf

A
  • Name and Age
  • PC
  • Systems review
  • Birth & Perinatal History (BFGD)
  • Feeding History
  • Growth
  • Immunisation History
  • Developmental History
  • PMHx including surgical
  • DHx and allergies
  • Social Hx
  • FHx
  • ICE
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4
Q

How can you explore the presenting complaint in a paediatric history?

A
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5
Q

How do you do a systems review in a paediatric history?

A

Ask about any changes to:

  • Dietary and Fluid intake
  • Urine output (changes in wet nappies)
  • Stool
  • Vomiting (projectile? how much? consistency?)
  • Fever (with thermometer or subjective?)
  • Rash
  • Coryzal symptoms (runny nose, or sounded ‘sniffly’)
  • Cough (triggers, any sputum)
  • Work of breathing
  • Weight change
  • Behaviour (their usual self?)
  • Pain
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6
Q

How do you ask about pre-natal, birth, neonatal and developmental history?

A
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7
Q

What should you ask in family history for paediatrics?

A
  • Anyone in the household experiencing similar symptoms?
  • Any diseases that run in the family?
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8
Q

What do you need to ask about in the social history for paediatrics?

A
  • Any input from social services?
  • Any child protection plans?
  • HEEADSSS
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9
Q

What is the HEEADSSS acronym for?

A

Addressing health risk behaviours and resilience factors in adolescents. Reassure confidentiality unless worries about safety

  • Home and Relationships
  • Education and Employment
  • Eating
  • Activities and Hobbies
  • Drugs alcohol and tobacco
  • Sex and Relationships
  • Self harm, depression and self image
  • Safety and abuse
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10
Q

How do you enquire about feeding history?

A
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11
Q

What immunisations do you have at each of these ages?

A
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12
Q

What is the definition of the following?

  • Embryogenesis
  • Fetal period
  • Perinatal period
  • Neonatal
  • Infant
  • Toddler
  • Pre-school
A

Embryogenesis: first 8 weeks after fertilisation

Foetal period: 3 month to 9 months

Perinatal period: 22 weeks to 7 days

Neonatal: 0-28 days

Infant: birth to 1 year

Toddler: 1-3 years

Pre-school: 3-5 years

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13
Q

What are the four domains of development in children?

A
  • Does HV have any worries?
  • Does school have any worries?
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14
Q

What are some differentials for a ‘fit’ in children?

A

Always remember breath holding seizures!!

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15
Q

How do you take a full developmental history of a child?

A
  • Obstetrics history (e.g infections in birth, any medications, any extra scans)
  • Delivery history (e.g gestation, mode, any admission to HDU?)
  • Developmental milestones
  • Communication mode
  • Any family history of developmental delay (inc siblings)
  • PMHx of child
  • DHx and allergies
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16
Q

How should you present a history in paediatrics?

A

History of Fever (5/7), Headache (3/7) and Vomiting (1/7)

Always write negatives e.g not sepsis because, not SOL because, no bilious vomiting

17
Q

What is a good tool to use for constipated children?

A

ERIC programme

18
Q

What is important to check when a child develops tourette’s?

A

Social circumstances

19
Q

What are some tips for mother’s to help with colic?

A
  • Reassurance that should resolve by 6 months of age
  • Holding, rocking, bathing the infant, ensuring optimal winding
  • Appropriate support such as friends, family, health visitor
  • Encouraging mother to continue breastfeeding wherever possible
20
Q

How do you measure the head circumference of a baby?

A
  • Placed above the ears and midway between the eyebrows and the hairline to the occipital prominence at the back of the head
  • Should be recorded to the nearest millimetre and repeated 3 times
  • The maximum of these 3 is recorded
  • Plot accurately on the growth chart
21
Q

What is the difference between a baby with IUGR and LBW?

A
  • Low birth weight when fulfilling potential and on projection e.g small parents
  • IUGR when not fulfilling potential (think about graph doctor showed us in F1 induction)
22
Q

How many ml of bottle milk is given to neonates?

A

~150mL/kg/24h (30mL=1oz) over 4–6 feeds

If small-for-dates up to 200mL/ kg/day, if large-for-dates, <100mL/kg

23
Q

When taking a feeding history in A and E what is important to ask?

A

If poor feeding how poor e.g how many bottles, how much being taken

If <50% feeds in bronchiolitis this is automatic admission

24
Q

How can you tell a child has Ricket’s by their hand x-ray?

A
25
Q

What is the most common cancer in children?

A

Leukaemias

26
Q

What is the most common cause of bacterial pneumonia in children?

A

S.Pneumoniae

27
Q

What murmur do you get with a VSD?

A

Pan systolic loudest at left lower sternal edge

28
Q

What conditions may have a third fontanelle?

A
  • Downs
  • Hypothyroidism
29
Q

What do you see on x-ray with duodenal atresia?

A

Double bubble

30
Q

What should you give to a child with HPylori first line?

A

Omeprazole, Amoxicillin and Clarithromycin

31
Q

What are the features of an innocent murmur?

A
32
Q

What EEG changes do you see in an absence seizure?

A

Bilaterally synchronous and symmetrical 3-Hertz spike-and-wave discharges that start and end abruptly

33
Q

What EEG changes do you see in an absence seizure?

A

Bilaterally synchronous and symmetrical 3-Hertz spike-and-wave discharges that start and end abruptly