Child & Health (history + examination) Flashcards
Outline general history taking for paediatrics (12)
Basics
(History of) Presenting complaint
Past medical history
Drugs
Allergies
Immunisations
Birth history
Feeding
Developmental history
Family history
Social history
Systemic enquiry
State the age group for neonates
0-4 weeks of age
State the age group for infants
1st year
State the age group for preschool children
2-<5 years
State the age group for school children
5-15 years
State the age group for ‘childhood’
1-15 years
State the age group for ‘adolescents’
13-19 years
What are the basics in paediatric history taking?
Full name, DOB, ideally CHI, address, GP
Date and time of history
Name of history taker and relationship of history giver to child
How would you take a history of presenting complaint? (7)
Commencement
Cessation
Constant or intermittent
Exacerbating or relieving factors
Associated symptoms
Contact with infectious disease (inc. animals)
Opinions - what do parents or referring GP think is wrong
What PMH is taken?
Past hospital admissions
Any other medical conditions
Any operations
Treatment already given
What drug history is taken?
Details of any regular medications taken
Details of any other medicines taken recently e.g. oral antibiotics, paracetamol
Form (liquid, suspension, granules etc)
Frequency
Duration of course
Other details (spacer)
Which allergy history is taken?
Medicine
Food
Previous allergic reactions (latex, soap, pets, dust etc)
How would you take a birth history? (7)
Where and when were they born, weight at birth
Term or premature
Antenatal problems (exposure, drugs)
Delivery problems (forceps, ventouse, planned/elective c-section)
Problems after birth - were they admitted to SCBU/NICU? If so how long? What treatment was received? (ventilation, CPAP, abx, O2 phototherapy)
Any other post-natal problems for mum or baby
What feeding history is taken?
Breast/bottle fed
Bottle - product, volume, frequency (overfeeding)
Older children - run through a typical day to get a better picture
Outline the social history taken in paediatrics?
Draw out a family tree - health status of siblings
Establish who else looks after the child
School/nursery - bullying
Parental occupation
Parental smoking (inside the house, during pregnancy)
Alcohol
Pets
Hobbies/sports
What immunisation history is taken?
Routine immunisations
BNFc/online green book - vaccination schedule
T or F: Some older patients will have had all the vaccinations on the current schedule - however the schedule will have changed since they were an infant
True
Outline general examination of newborns
Height, weight, OFC in babies, centiles
Obs: temperature, HR, RR< oxygen sats SpO2, sometimes BP
Inspection (comfortable/distressed, cyanosis/pallor, syndromic features in cranium/eyes/face/hands, signs of existing conditions (wheelchair, tracheostomy, walking aids)
Outline the CVS examination of a newborn
Inspect - cyanosis, squatting, dyspnoea, oedema, finger clubbing, distension of veins
Palpate - apex beat, thrills, heaves
Pulse - radial (brachial, femoral, or carotid can be used in younger patients if difficult)
Heart rate and rhythm
Auscultate - rhythm, heart sounds, murmurs
Outline the respiratory examination of a newborn
Inspect - chest expansion, deformities, finger clubbing
Listen - stridor, wheeze, cough, grunting
Palpation - tracheal deviation, cervical lymphadenopathy
Percussion - hyperresonnance, dullness
Auscultation - fine/coarse crackles, rubs
Outline the abdominal examination of a newborn
Inspection - distension, peristalsis, swelling, umbilical abnormalities, hernia
Palpation - hands, tenderness, guarding, masses, liver, spleen, hernia, inguinal lymph nodes
Percussion - shifting dullness, full bladder
Auscultation - bowels sounds
Outline the ENT examination of a newborn
Ears
Ear drum reflectivity - gas bubbles, erythema, wax, perforation, grommets, foreign bodies
Nose - blockage, foreign bodies, epistaxis, polyps
Throat
Tonsil erythema - size, pus, tongue, candida, ulcers
How are ears examined in a child?
Keep child sitting upright on your knee, turned to one side, with one hand placed around the shoulders and the other above the ear to hold the head still
How is a throat examined in a child?
Keep child facing forward and sitting upright on parent’s knee, with one hand around both shoulders, and the other on the forehead to hold the head still
