History taking Flashcards
What is pediatrics primarily concerned with? (The scope of pediatrics)
Pediatrics is the science of growth and development and is dependent on and committed to families.
Why is pediatric history-taking important?
Pediatric history is the foundation for the physician/patient/parent relationship and is the main basis for diagnosing medical conditions.
What are common reasons for errors in diagnosis?
More errors are made due to inadequate history-taking and superficial examinations than any other cause.
What are the objectives of pediatric history-taking?
-Understand content differences compared to adult history.
-Recognize how a child’s age impacts history-taking.
-Highlight the role of parents in the process.
What are the goals of taking pediatric history?
-Determine why the patient/parent sought medical attention.
-Identify what the patient/parent is most worried about.
-Direct appropriate examinations and investigations.
-Reach a diagnosis or form a differential diagnosis.
What are the key content differences in pediatric vs. adult history?
Pediatric history includes perinatal, developmental, nutritional, social, and immunization histories.
Why are parents critical in pediatric history-taking?
Parents interpret signs and symptoms, especially in children under four, and provide insights into parent-child interactions and behaviors.
What is the importance of listening to mothers during pediatric history-taking?
-Mothers are excellent observers of their children.
-They provide accurate and thorough descriptions of complaints.
-A good doctor is a good listener who considers mothers’ observations seriously.
What are some tips for listening to mothers?
Introduce yourself and establish rapport.
Quote mothers verbatim.
Let mothers define terms and describe events in their own words.
Ask, “When was he last well?”
Give individual attention and devote time.
What is the outline of a general pediatric history?
Person providing history (relationship and reliability).
Date, patient’s name, birthdate, age, gender, and residence.
Chief complaint and history of present illness.
What are the components of history of the present illness?
Details of the chief complaint: onset, progression, chronology, aggravating/alleviating factors.
Relevant negative information.
When the patient was last entirely well.
What are the systems reviewed during history-taking?
HEENT: headaches, visual problems, ear infections, snoring.
Cardiac: cyanosis, dyspnea, chest pain.
Respiratory: wheezing, chronic cough.
GI: diarrhea, vomiting, jaundice.
GU: dysuria, hematuria.
Musculoskeletal: joint pain, injuries.
Skin and lymph: rashes, lumps.
Allergy: eczema, drug reactions.
What should be included in the past medical history?
Hospitalizations, surgeries, medications, allergies.
Recent travel or exposures.
Injuries and communicable diseases.
What are the components of perinatal history?
Prenatal: gestation length, maternal health, illnesses, and insults.
Natal: birth weight, delivery mode, complications, Apgar score.
Postnatal: feeding, respiratory difficulties, malformations.
What is included in the nutritional history?
Breastfeeding vs. bottle-feeding (start, stop times, formula type).
Weaning age and vitamin supplements.
Current diet and feeding patterns.
What aspects are assessed in developmental history?
Gross motor skills.
Fine motor skills.
Vision, speech, and hearing.
Social development.
What should be noted in immunization history?
Time and type of each vaccine given.
Complications or booster doses.
Reasons for missed vaccinations.
What is the goal of social history?
To understand the child’s social and cultural environment, including risks and stresses at home and school.
What are some key items in social history?
Living conditions, parental occupations, and education levels.
Family relationships and discipline methods.
School performance, travel history, and exposure to smokers or pets.
Why is family history important?
Families share genetics, diseases, and environments. It includes diseases in parents, siblings, and grandparents, and history of consanguinity or recurrent miscarriages.
What are some tips for effective history-taking?
Use terms like “the mother” or “the father” instead of personal relationships.
Clarify lay language terms.
Observe the child’s behavior and interactions during relaxed settings.
What is the importance of involving children in history-taking?
Children over five can provide their accounts. Their descriptions, like “a laser beam going through my stomach,” offer valuable insights.
What are the concluding steps of history-taking?
Develop a diagnostic impression.
Create a problem list.
Describe each abnormality anatomically and pathologically.
