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Paediatrics > An approach to assessing children > Flashcards

An approach to assessing children Flashcards

1
Q

What can change depending on the age of the child?

A

Your own approach to history taking and examination
Common pathologies differ
Conditions manifest differently at different ages

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2
Q

What is important to do when preparing for a paediatric consultation?

A

Why the child has come to see you or been referred
Do you know the child’s name and sex?
Do you have an opportunity to observe child before “starting” assessment?
What is the likely differential diagnosis?
What conditions need to be ruled out?
What info have nurses gathered?

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3
Q

What is important to do while taking history?

A

Gather important information
Try to rule out significant pathology
Helps examination be more targeted
Be calm and empathetic
Show interest in what parents are saying
Facilitates dealing with concerns and anxieties

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4
Q

What’s important to consider regarding the age of the child?

A

Consider age and developmental stage
Consider language and intellectual skills
Typically most questions will be directed to parents
Some questions appropriate for child
Different perspectives may be gathered from both parent and child
Pre-verbal children still communicate
Older children can be quiet

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5
Q

What should be done in introduction in history?

A

Introduce yourself, identify patient and who is with them
Generate rapport with child
Note your “examination” observations

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6
Q

What’s important to find out in the history of presenting complaint?

A 
Onset, progress, variations, effects, observations
Chronological stages (including GP/A&E/Ward)
General/systems enquiry
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7
Q

How much should a baby increase weight by in the first 6 months?

A

Around 150-200g per week for the first 6 months

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8
Q

What units can parents use to to weigh their child?

A

Grams
Stones
Pounds and ounces

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9
Q

How many grams are in 1 pound?

A

About 450 grams

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10
Q

How many grams are in an ounce?

A

About 28 grams

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11
Q

How many ounces are in a pound?

A

16

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12
Q

How many pounds are in a stone?

A

14

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13
Q

How many mls are in a fluid ounce?

A

About 28mls

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14
Q

How much feed should a baby take each day?

A

Around 140-180 ml/kg/day

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15
Q

How should you ask about a baby’s stool?

A 
Distinguish between child in nappies vs independent toileting
Frequency - per day, week, or even month
Size, shape, appearance, and consistency
Difficulties passing
Pain on passing
Blood or mucus seen
Parents are sometimes surprised
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16
Q

What are the 7 stages of the bristol stool chart?

A

Type 1 - Seperate hard lumps like nuts - hard to pass
Type 2 - sausage shaped but lumpy
Type 3 - like a sausage but with cracks on the surface
Type 4 - Like a sausage or snake, smooth and soft
Type 5 - Soft blobs with clear cut edges
Type 6 - fluffy pieces with ragged edges, mushy stool
Type 7 - Entirely liquid

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17
Q

What should be asked about in the birth history?

A

Detail depends on age and presentation

Some features may be very relevant years later

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18
Q

What should be asked about in developmental history?

A

What can they do, any concerns?

Basic enquiry about walking, words, support

19
Q

What are the key components of paediatric history?

A 
Introduction
Presenting complaint/history of presenting complaint
Nutritional history
Birth history
Past medical history
Immunisation history
Developmental history
Drugs and allergies
Family and social history
20
Q

What should be asked about in nutritional history?

A

Weight
Feeding
Stool

21
Q

What is important to cover in family and social history?

A

Key stage in assessing patients - recent and related health issues, parents/siblings, relationship dynamics
School and nursery - common source of infective contacts, give insight into developmental process
Parental social history impacts on child’s health

22
Q

How can the parental social history impact on the child’s health?

A 
Smoking
Alcohol
Drugs
Occupation
Stress
23
Q

How do you close a paediatric consultation?

A

Discuss why they came to see you, concerns, and what they’re looking to understand
Summarise key features
Check understanding and safety net
Document history and discussions
Note date, time, who was present/gave history

24
Q

Is examination expected in year 3 OSCE?

A

No

25
Q

What tells you the most in examination?

A

Observation

26
Q

What should be examined in paediatrics?

A 
ABCDE and vital signs
General condition and peripheries
Respiratory system
CVS
GI system
Neuro and MSK
ENT and skin
Developmental skills
Measurement and centile
27
Q

How can you start an examination?

A

Observe first
Be friendly and smile
Speak to the child, even if they are weeks old
Get down to their level
Be careful moving them - keep parents close
Gentle handling and gradual exposure
Show interest in their toys and play

28
Q

What general things are observed for?

A

Appearance
Play
Interaction
Obs

29
Q

What respiratory features are observed for?

A 
Effort
Noise
Rate
Recession
Nebulisers
Are they on oxygen
NOT SPUTUM POTS
30
Q

What CVS features are observed for?

A

Colour of the child

Perfusion

31
Q

What GI features are observed for?

A

Feeding
Vomit
Abdominal distension
Abdominal movement

32
Q

What neuro features are examined for?

A

Alertness
Interaction
Play
Posture

33
Q

What MSK features are observed for?

A 
Mobility
Limbs movements
Posture
Splints
Mobility aids
34
Q

What features are looked for over the skin?

A 
Rashes
Bruises
Infusions
Tubes
Lines
35
Q

What can you look for environmentally unrelated to medicine?

A 
Toys
Pictures
Cards
Games
Books
36
Q

What is examined in the hands?

A 
Warmth
Cap refill
Radial/brachial pulses
Clubbing
Nail changes
Hand skills
Pen marks
37
Q

What is examined in the head and face?

A 
Eyes - jaundice
Lips (colour, moisture)
Tongue
Nose
Scalp changes
Bruises
Rashes
Fontanel
38
Q

What is examined in the neck?

A

Rashes and nodes (easier from the front); size, shape, mobility, position, consistency, symmetry
Tracheal tug

39
Q

What should be examined for in the chest and back?

A 
Heart murmurs
Apex beat, thrills, chest expansion
Breath sounds
Percussion
Resonance and fremitus
Rashes and skin marks
Spinal alignment, deformity, sacral dimples
40
Q

What should be examined in the abdomen and groin?

A

Tenderness - watch face and movement
Masses (esp stool) and organomegaly - spleen, liver, kidneys
Bowel sounds and bruits
Femoral pulses - essential in infants
Hernias and testis
Genital/anal appearance (routine in nappies but often not appropriate for older children)
Do not do a rectal exam

41
Q

What should be examined in the legs and feet?

A

Mobility, changing posture, movements, tone
Reflexes, clonus
Power, coordination, sensory assessment
Pulses, warmth, cap refill, colour, mottling
Rashes, bruises, marks
Deformities and gait

42
Q

What can play be used for?

A

Illustrate something
A distracter
A clinical tool

43
Q

How can you improve your paediatric history and examination?

A 
Use child friendly language
Recognise normality
Leave unpleasant things to the end
Be honest
Develop play skills
Document systematically
Practice

Paediatrics (25 decks)

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