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Pediatrics > History Taking Pedics > Flashcards

History Taking Pedics Flashcards

1
Q

History format

A
  • Informant
  • Demographics
  • Presenting complaint
  • History of presenting complaint
  • ODQ
  • systemic review
  • past medical and surgical history
  • drug history
  • pregnancy, birth and neonatal history
  • nutrition history
  • immunization history
  • developmental history
  • family history
  • social history
  • summary
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2
Q

History of Presenting complaint

A
  • onset
  • duration
  • previous episodes
  • relieves/ aggravates
  • time course of the problem
  • is it getting worse
  • associated symptoms
  • has the child’s life being affected and what has the family done
    OPDRATISH
    Also know what prompted referral to doctor and what the parents think or fear
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3
Q

PMSH

A
  • maternal obstetric problems, delivery, prolonged rupture of membranes, maternal Pyrex is, strep B
  • birth weight and gestation
  • jaundice, diabetes,
    Past illness, hospital admission, accidents, injuries
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4
Q

Social history

A

This is very important

  • alcohol and drug abuse
  • poverty by knowing where the parents live, do they have mosquito nets or trap doors, toilet system, number of windows, drinking water and age of parents
  • parental psychiatric disorder
  • unstable parenting
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5
Q

Clubbing

A

Chronic suppurative lung dx: cystic fibrosis

  • congenital HD
  • cirrhosis
  • inflammatory bowel disease
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6
Q

Suspense: labored breathing

A
  • nasal flaring
  • expiratory grunting: to increase positive end- expiratory pressure
  • use of accessory muscles esp sternocleidomastoid
  • recession of suprasternal, intercostal and subcostal muscles
  • difficulty feeding
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7
Q

Hyper expansion or barrel shaped

A
  • copd

- asthma

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8
Q

Harrison’s sulcus or groove

A 
Ddx
- asthma or obstructive respiratory dx
- rickets
- blocked nasopharyngeal due to adenoid enlargement
Presence of hyperinflated lungs
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9
Q

Bronchiolitis

A
  • usually affects children less than two years
  • labored breathing
  • hyper inflated chest
  • chest recession
  • The most reliable clinical feature of bronchiolitis is hyperinflation of the chest, evident by loss of cardiacdullness on percussion, an upper border of the liver pushed down to below the 6th intercostal space,
  • hyperresonant
  • fine crackles in all zones
  • wheezes may or may not be present
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10
Q

Pectin carinatum ( pigeon chest)

A
  • marfan syndrome
  • rickets
  • childhood rsp dx: asthma
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11
Q

Pectins excavatum or funnel chest or cobbler’s chest

A
  • developmental defect
  • Due to displacement of heart the apex beat is shifted further to the left and the ventilatorv capacity of the lung is restricted
  • seen in Marfan syndrome, thoracic kyphoscoliosis
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12
Q

Pneumonia

A
  • reduced on affected side chest movement
  • rapid, shallow chest breaths
  • dull on percussion
  • bronchial breathing
  • crackles
  • infants with pneumonia may not have any abnormal signs on auscultation
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13
Q

Asthma

A
  • reduced but hyperinflated
  • use of accessory muscles
  • chest wall retraction
  • hyperresonant
  • wheeze
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14
Q

Pulse volume

A

Small: aortic stenosis, circulatory insufficiency
Increased: high cardiac output(stress, anemia), pregnancy, fever
Collapses: patent ductus arteriosus, aortic regurgitation

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15
Q

Features of heart failure in infants

A
  • poor feeding or failure to thrive
  • sweating
  • tachypnea
  • gallop rhythm
  • cardiomegaly
  • hepatomegally
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16
Q

Splitting of the second heart sound is easily heard in

A

Children

In inspiration it is separated but I’m expiration it’s together

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17
Q

A murmur is significant

A
  • conducted all over the precordium
  • loud
  • thrill
  • diastolic murmur
  • accompanied by other abnormal cardiac signs
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18
Q

Precordial bulge

A

Ddx: cardiac enlargement

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19
Q

Ventricular impulse

A

Ddx

  • visible if chest is thin
  • hyper dynamic circulation
  • left ventricular hypertrophy
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20
Q

Apex not palpable

A

Ddx:

  • plump normal infants
  • dextrocardia
  • heave from left ventricular hypertrophy
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21
Q

Right ventricular heave

A

Right ventricle hypertrophy

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22
Q

Heart sound

A
  • fixed splitting of second heart sound in atrial septal defect
  • third heart sound in mitral area is normal in young childreb
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23
Q

Radiation of murmurs

A
  • to neck in aortic stenosis

- to back in coarctation of the aorta or pulmonary stenosis

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24
Q

Hepatomegalh in CVS

A
  • this is an important sign of heart failure in infants
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25
Q

Coatctation of aorta

A
  • femoral pulses may have a decreased volume or may be impalpable in infants
  • brachiofemoral delay in older children
26
Q

Protuberant abdomen or abdominal distension

A
  • muscle hypotonia
  • 5F’s
  • organometaly
  • bowel obstruction
27
Q

Localized abdominal dilation

A

Upper abdomen: hepatomegaly,spleenomegaly , gastric dialatiom from pyloric stenosis
Lower abdomen: distended bladder, masses
Lower abdomen : distended bladder, masses

28
Q

Peristalsis of sbdomen

A
  • pyloric stenosis, intestinal obstruction
29
Q

tenderness

A

Localized: appendicitis, hepatitis, pyelonephritis
Generalized: peritonitis, Mese Teri adenitis

30
Q

Abnormal masses

A
  • Wilma tumor: renal mass, does not cross the midline
  • Neuroblastoma: irregular form mass, may cross the midline, child is usually unwell
  • faecal mass: mobile, non tender, indentable
  • intussusception: acutely unwell, mass may be palpable, felt in right upper quadrant
31
Q

Causes of hepatomegaly

A

Infection: infectious mononucleosis, hepatitis, malaria
Hematological: sickle cell anemia a, thalassemia
Liver dx: portal hypertension, poly cystic dx
Malignancy: leukemia, lymphoma, neuroblastoma, Wilma tumor, hepatoblastoma
Metabolic:Glycogen and lipid storage disorders mucopolysaccharidoses
CVS: heart failure
I

32
Q

Bowel sounds

A

Increased: intestinal obstruction, acute diarrhea

Decreased or absent: paralytic ileum’s, peritonitis

33
Q

Asthma

A

Lung hyperexpansion in bronchiolitis or asthma can displace the liver and spleen causing hepatospleenomegaly

34
Q

Toe walkers or toe-heel gait

A

Ddx:

  • pyramidal tract dysfunction
  • foot drop (common or superficial perineal nerve dysfunction)
  • tight tendo avhillew
35
Q

Children below three years will lie prone to stand

If seen in beyond three years

A
  • neuromuscular weakness ( Duchenne muscular dystrophy)

- low tone due to brain

36
Q

Gower sign

A

The Gower sign is a classic physical examination finding in MD and results from weakness in the child’s proximal hip muscles. To get up from a sitting or supine position, the child must first become prone on the elbows and knees. Next, the knees and elbows are extended to raise the body

37
Q

Muscle bulk

A
  • wasting secondary to cerebral palsy, meningomyelocele, muscle disorder , previous polio
  • increased: Duchenne muscular dystrophy
38
Q

Brisk reflexes

A
  • pyrimidial disorder
39
Q

Absent reflex

A
  • Neuromuscular problems
40
Q

Loss of sensation

A

Ddx

  • meningomyelocele
  • spinal lesion
41
Q

A palpable bladder or absent perineal sensation

A
  • spinal lesion

- cauda equine lesion

42
Q

Variable size and shape of lymph nodes

A
  • infections: viral- infectious mononucleosis, TB

- rare causes: malignant dx, Kawasaki disease, cat scratch

43
Q

General enquirer in Pedics

A
  • general health: how active and lively
  • normal growth
  • pubertal development
  • feeding/ drinking/ appetite
  • any recent change in behavior or personality
44
Q

Situations where a patient has no pulse

A
  • shock

- cardiac arrest

45
Q

Features suggesting a murmur is significant

A
  • can be heard all over the precordium
  • loud
  • thrill
  • diastolic murmur
  • accompanied by other cardiac abnormal signs
46
Q

Ventricular impulse

A
  • if chest is thin
  • left ventricular hypertrophy
  • hyper dynamic circulation
47
Q

Apex beat not palpable in

A
  • dextrocardia
  • obese children
  • left ventricular hypertrophy
48
Q

Apex beat not palpable in

A
  • dextrocardia
  • obese children
  • left ventricular hypertrophy
49
Q

Flats

A
  • malabsorption

- intestinal obstruction

50
Q

Tenderness

Localized

A
  • appendicitis
  • hepatitis
  • pyelonephritis
  • peritonitis
  • generalized in mesenteric adenitis
51
Q

Pain

A
  • back bent on walking may be from papas inflammation in appendicitis
52
Q

Abnormal masses

A
  • Wilms tumor: renal mass, sometimes visible, does not cross the midline
  • neuroblastoma: irregular firm mass, may cross the midline; the child is usually very unwell
  • faecal mass: mobile, non tender, indentable
  • intiussuception: mass may be palpable most often in right upper quadrant
53
Q

Causes of hepatomegaly

A
  • infection: congenital, infectious mononucleosis, hepatitis, malaria, parasitic infection
  • haematological: sickle cell anemia, thalassemia
  • liver disease: chronic active hepatitis, portal hypertension, poly cystic disease
  • malignancy: leukemia, lymphoma, neuroblastoma, Wilms tumor,hepatoblastoma
  • metabolic: glycogen and lipid storage disorders
  • cardiovascular: heart failure
  • apparent: chest hypeeexpansion from bronchiolitos or asthma
54
Q

Causes of spleenomegaly

A
  • infection: viral, bacterial, protozoal (malaria, leishmaniasis), parasites, infective endocarditis
    Haematological: haemolytic anemia
    Malignancy: leukemia, lymphoma
    Other: portal hypertension, systemic juvenile idiopathic arthritis
55
Q

Bowel sounds

A

Increased bowel sounds: acute diarrhea, intestinal obstruction
Decreased bowel sounds or absent: paralytic illeus and peritonitis

56
Q

Toe walkers

A
  • idiopathic

- pyrimidial or corticospinal dysfunction

57
Q

Foot drop

A
  • common or superficial perineal nerve lesion
58
Q

Duchenne muscular dystrophy

A
  • possible learning and cognitive difficulties
  • decreased heart function and cardiomyopathy leading to heart failure
  • weakend diaphragm leading to pneumonia
  • loss of muscle mass, weakness and fibrosis hence require wheel chair
  • brittle and weak bones
59
Q

Beckweidmann syndrome

A
  • mild microcephaly
  • ear creases or ear pits
  • large prominent eyes
  • macroglossia
  • congenital hernia
  • cryptorchidism
  • neonatal hypoglycemia
  • gigantism
  • increased risk of cancer
  • hemihyperplasia lateralized overgrowth
60
Q

Plantar extension

A
  • pyrimidial dysfunction

Pediatrics (10 decks)

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