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Paeds > History and examination > Flashcards

History and examination Flashcards

1
Q

What is part of the introduction to an examination?

A

WIPE (wash hands, introduce self, cheack pt details, explain & consent)
Should also find out relationship of adult to child

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2
Q

What is looked for in the general inspection?

A

Activity
Irritability
Colour
Adjuncts around bed

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3
Q

What shows increased respiratory effort?

A

Resp rate
Recession (subcostal, intercostal, sternal)
Tracheal tug and head bobbing
Accessory muscle use

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4
Q

What do you look for to assess hydration status?

A

Wet nappies
Mucous membranes
Skin turgor
Cap refill time (central, peripheral)

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5
Q

Normal resp rate & HR in infant (under 1)

A

30-40 RR

HR 110-160

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6
Q

Normal RR and HR in child aged 1-2

A

RR 25-35

HR 100-150

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7
Q

Normal RR and HR in child aged 2-5

A

RR 25-30

HR 95-140

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8
Q

Normal RR and HR in child aged 5-12yrs

A

RR 20-25

HR 80-120

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9
Q

Normal RR and HR in child over 12

A

RR 15-20

HR 60-100

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10
Q

What questions do you ask mum in a NIPE?

A

Labour:
How long since delivery, type of delivery, problems in labour, medications in labour
Mother:
Ant fevers, overall health in pregnancy, Hx of congenital hip dysplasia, eye problems, ear problems, heart problems
Baby:
Preterm/term/post, weight, feeding? Urine within 12 hrs, meconium within 48 hrs, breathing

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11
Q

What overall things do you look for in a NIPE?

A

Cry
Colour (cyanosis, pallor, jaundice, rashes)
Birth trauma (subconjunctival haemorrhage, forcep marks, cephalohaematoma)
Dysmorphic features (cleft lip, jaw)
Posture, tone and movements

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12
Q

What do you check at the head end?

A

Cepahlohaematoma, cranium deformities, fontanelles and sutures
Face for dysmorphic features, cleft lip
Feel for cleft palate/high arched palate, suck reflex
Red reflex in eyes

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13
Q

What do you look for in the arms?

A

Check shoulders are aligned and clavicles
Extend arms
Palmer creases
Count digits

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14
Q

What do you examine for chest/abdomen

A

Chest: RR, cap refill, resp distress isgns, auscultate heart and lung sounds
Abdo: inspect for distension, scaphoid abdo due to diaphragmatic hernia, umbilical stump, palpate for masses and kidneys

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15
Q

What do you look for in the groin?

A

Femoral pulses
Genitalia (check testes distended, vulval fusion)
Patent anus

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16
Q

Hip test in NIPE?

A

Ortolani’s test (flex hips to 90º, turn out to full abduction and apply anteiror force to upper leg. CLICK relocation)
Barlow’s (Adduct hips and flex to 90º, push posteriorly in line of femoral shaft, CLICK dislocation)

17
Q

What do you check for in the legs in a NIPE?

A 
Extend, check same length
Talipes? (club foot)
Calcaneovalgus? (abducted forefoot, dorsiflex ankle)
Rotation at ankle
Count digits
18
Q

What do you look for on a baby’s back in a NIPE?

A

Lipomas, port wine stain, mongolian blue spot

Palpate for spinal abnormalities, look for tuft of hair-> spina bifida

19
Q

What reflexes do you test for in a NIPE?

A

Grasp

Startle (moro)

20
Q

What do you say to finish off a NIPE?

A

To complete my exam I would measure head circumference, length and weigh the baby
I will fully document my findings in the infant’s red book
Summarise

21
Q

What are the added parts of a paeds hx?

A 
Birth
Feeding
Growth
Development
Immunisations
22
Q

What do you ask about birth?

A

Pregnancy (problems, maternal illness/drug use)
Place of birth, gestation, weight
Mode of delivery, complications
Resus required? injury? malformations?
Neonatal jaundice? fits? fevers? feeding?

23
Q

What do you ask about feeding?

A 
Diet and appetite (breast/bottle)
Breast: feed every 2 hrs?
Bottle: which formula, 150ml/kg/day
Weaning 6-12 months puree, mash, solids
Solids and cows milk from 12 months

Toileting (training 2-4yrs, dry by day 2 yrs, dry by night 3-4yrs)
Frequency

24
Q

What do you ask about growth

A

Look at red book

Puberty if older (11yrs girls, 12 yrs boys)

25
Q

What do you ask about development? Screen?

A 
Any concerns
School progress/attendance
Screen
Smiling by 6 weeks
Sitting by 9 months
Turn to sound 6 months
First words 18 months
Walking 18 months
Talking 3 word sentence 3 years
26
Q

Social history in paeds?

A 
Family unit
Anyone who smokes? inside/outside
Housing situation
Social services involved?
Playgroup from age 2, nursery from 3, school 5-16
Hobbies/travel/pets
27
Q

Name a strategy for consultations with adolscents

A 
H – Home
E – Education & Employment
A - Activities
D – Drugs
S – Sexuality
S – Suicide/depression

Paeds (14 decks)

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