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Paediatric osce > History taking > Flashcards

History taking Flashcards

1
Q

What should be asked in the birth section?

A
  • Pregnancy – any problems, maternal illness/drug use
  • Birth history
  • Place of birth
  • Gestation (37-40 weeks) & birth weight (2.5-4.5kg)
  • Mode of delivery & birth complications e.g. resuscitation required, birth injury, malformations
  • Neonatal problems e.g. jaundice, fits, fevers, bleeding, feeding problems
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2
Q

What should be asked about development?

A
  • Any concerns
  • School progress & attendance
  • Developmental screen
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3
Q

What is in a developmental screen?

A

Smiling by 6 weeks
Sitting by 9 months
Turns to sounds by 6 months
First words by 18 months
Walking by 18 months
Talking 3 word sentences by 3 years

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4
Q

What should be asked about growth?

A
  • Weights – ‘The Red Book’ (personal child health record)
  • Puberty if older (starts at 10-11 years in girls, 12-13 years in
    boys)
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5
Q

What should be asked about feeding?

A

Diet and appetite
Toileting

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6
Q

What should be asked about diet and appetite?

A
  • Breast/bottle milk (<12 months) – which? If formula, which one? Home much? (150-200ml/d or breast feed every 2
    hours)
  • Weaning (6-12 months) – starts with pureed jars, then mashed up food, then solids gradually added
  • Solid meals and cow’s milk (>12 months)
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7
Q

What should be asked about toileting?

A
  • Toilet training (2-4 years, dry by day 2 years, dry by night 3-4 years)
  • Frequency – wet nappies? (usually ~5 soaking wet nappies per day and 3 yellow stools)
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8
Q

What should be asked about social history?

A
  • Family unit (parents, siblings, who lives at home) – draw family tree of who’s at home
  • Anyone smokes in the family? (inside or outside)
  • Housing situation
  • Social services involvement
  • Playgroup (2-5 years), nursery school (3-4 years) or school (5-16 years) – performing well?
  • Other e.g. hobbies, travel, pets
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9
Q

What should be asked about family history?

A
  • Anything relevant to HPC
  • Anyone else ill?
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10
Q

What should be asked about drug history?

A
  • Immunisations – up to date?
  • Current medication (including crèmes etc) – include dose, route, compliance
  • Relevant recent medication e.g. course of steroids for asthma
  • Allergies – drug or food or others
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11
Q

What should be asked about past medical history?

A
  • Medical problems
  • Previous illness, accidents, surgery
  • Previous hospital/A&E visits
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12
Q

Screening?

A

FAIRS

F - Fever
A - Activity
I - Infection
R - Rashes
S - Secretions

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13
Q

How to explore a fever?

A

When did you first notice it?
How high was it - was it confirmed with a thermometer
Did anything help – Calpol

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14
Q

How do you explore a rash?

A

and is it itchy – scratching?
does it spread - Location – start/ spreading
shape
Onset

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15
Q

How to explore activity?

A

Alertness
Behaviour
Sleeping
Crying

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16
Q

Explore alertness?

A

Drowsiness, floppiness

17
Q

Explore behaviour?

A

Are they their usual self, including activity level, mood, and social interaction
Playing as per normal
More irritable?

18
Q

Explore sleeping?

A

Poor sleeping? More tired as per usual

19
Q

Explore crying?

A

High pitched? Different?

20
Q

how do you explore a cough?

A
  • Time
  • Is it productive – any sputum; colour; amount
  • Frequency
  • Any particular triggers or times in the day
  • Describe the cough – features; barking; whooping
  • Chesty/ upper
  • Make it worse – cold?
21
Q

Explore work of breathing?

A
  • Are they breathing faster?
  • Is it louder?
  • Is it a lot of effort to breathe? Do their ribs show?
    Nasal flaring
    tracheal trug
    tripoding
    head bobbing/ lag
  • Any audible sounds – Noisy breathing, grunting (stridor, croup, wheeze)
    Wheeze- how many times a week? Any night-time waking
    Which part of the body do you think it comes from
    Crackling/ vibrating
22
Q

How to ICE in paediatrics?

A

What are your thoughts on what is happening?
Is there anything in particular that is worrying you?
Is there anything that you were hoping we could do for you today?
Effects on life
Have taken time off school?

Paediatric osce (5 decks)

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