Paediatric Assessment, History Taking and Examination Flashcards
What aspects of the birthing PMH would you want to ask about?
- Gestation
- Mode of delivery
- Birthweight
- Resuscitation required?
- Birth injury/Malformations
What vaccine can be given annually from age 2-11?
Influenza
What is a neonate defined as?
<4 weeks old
What can occur within the first few days of life with regard to weight?
Babies can lose up to 10% of their initial weight
What would you ask about if there was a suspected neurological problem in a neonate?
- Seizures
- Attacks
- Jitters
What is the average weight gain between 9-12 months of life?
50-75g/wk
What would you ask if you suspected a neurological problem in an older child?
- Headaches
- Fits
- Odd sensation
- Drowsyness
- Schooling
- Vision
- Hearing
- Co-ordination
What aspects of the Neonatal PMH would you want to ask about?
- Jaundice
- Fits/Fevers
- Bleeding
- Feeding problems
- Special care
- Operations
- Screening tests
What is the average weight gain within the first 3 months of birth?
Approximately 200g/wk
Why do neonates grunt?
Increased air pressure against a partially closed glottis - similar effect to pursed lipped breathing in COPD patients -> opens easily collapsible airways due to back pressure
What is the average weight gain between 3-6 months of life?
Approximately 150g/wk
What is the average feed volume for children before being weaned onto solids?
150ml/kg (140-180 ml/kg)
What are the key components to a full paediatric history?
- PC/HPC
- PMH
- Birth History
- Immunisations
- Development
- Drug History and allergies
- Family history
- Social History/Personal History
What are general things you want to know about presenting illness in a child?
- When/how did it start?
- What were they like before?
- How has it progressed?
- What makes it worse/better?
- Feeding issues? - especially infants
What is the average weight gain between 6-9 months of life?
Approximately 100g/wk
What would you ask about with in an older child with breathing problems?
- Exercise limitation
- SOB
- Cough
- Wheeze
- Haemoptysis
- Chest pain
What are the components of a paediatric history which are not in an adult history?
- In utero/birth/neonatal problems
- Immunisations
- Developmental history
- Personal
If a baby is ill, what can their feed intake drop to?
Approximately 100 ml/kg/day
What changes in colour would you potentially ask about?
- Pale - e.g. anaemic
- Yellow - jaundice
- Blue - cyanotic heart disease; respiratory distress
- Red - rash; straining etc.
What would you want to ask about in a vomiting child to help determine a differential?
- Colour - green; yellow etc.
- Consistency
- Blood
- Effort - effortless -> GORD; Projectile -> Pyloric Stenosis
- Time after feeding
- How many times/how much
What vaccines are given at 4 months?
- DTaP/IPV/Hib - Diptheria, tetanus, Pertussis, Polio, H. flu B
- PCV - Pneumococcal conjugate
- Men B
What would you ask about a childs crying?
- Increased/Decreased
- Pitch
What would you ask about the stool of a child to help determine a DDx?
- Frequency
- Size/Shape
- Consistency
- Colour
- Pain when passing
- Blood/mucus
What is the definition of an infant?
<1 year old
What vaccines are given at around 14 years of age
- Td/IPV - Tetanus, diptheria, polio
- MenACWY
What would you ask about breathing problems in a toddler to determine a DDx?
- Cough
- Exertional dyspnoea
- Sputum
- Haemoptysis
What is the definition of a toddler?
1-2 years
What could you ask about if you suspected there was a GI problem in an older child?
- Appetite
- D&V
- Abdominal Pain
- Stool frequency
- Rectal Bleeding
- Weight loss
How many grams of feed should a baby be taking in per day?
20-30 grams - at spaced intervals
What would you ask about the urine in a neonate/toddler to determine a DDx?
- Wet nappies - how often
- Colour - any blood
- Smell
- Output - reduced/stopped
What vaccines are given at 2 months?
- DTaP/IPV/Hib - diptheria, tetanus, pertussis, polio, H. flu B
- PCV - Penumococcal conjugate
- Men B
- Rotavirus
What things could you ask about if you suspected a GI problem in a neonate?
- Appetite
- Diarrhoea
- Vomiting
- Jaundice
- Bleeding/mucus
- Appropriate weight gain
What vaccines are given at 3 years and 4 months?
- DTaP/IPV
- MMR
What vaccine is given to girls age between 12-13 years old?
HPV (16+18)
What aspects of the PC/HPC would you ask about?
- Colour
- Activity/floppy/lethargic
- Feeding
- Weight gain
- Vomiting
- Stools
- Urine
- Crying
- Breathing
- Not smiling
What is the definition of pre-school?
2-5 years
What would you ask about the urine in an older child?
- Dysuria
- Haematuria
- Polyuria
- Bed wetting
- Sexual development
- Thrist
What vaccines are given at 3 months?
- DTaP/IPV/Hib - Diptheria, Tetanus, pertussis, Polio, H. flu B
- Rotavirus
What ages are vaccines given at?
- 2 months
- 3 months
- 4 months
- 12-13 months
- 3 years and 4 months
- 12-13 - females only
- 14 years
What would you ask about problems with breathing in a neonate to determine a DDx?
- Grunting
- Wheeze
- Cyanosis
- Stridor
What aspects of in utero PMH would you ask about?
Any problems - abnormal bleeding, medication, alcohol, recreational drugs
What would you ask to determine a child developmental history?
Ask about ages at which the child learned to do things e.g. sit, crawl, stand, walk etc.
What would you ask about if you suspected a neurological problem in a toddler?
- Seizures
- Drowsyness
- Hyperactivity
- Decreased hearing
- Decreased vision
- Gait
What is the definition of an adolescent?
Teenage years (variable depending on time of onset)
What would you want to ask about in the Social/Personal History?
- Who is at home?
- Playing
- Eating
- Sleeping
- Schooling
- Pets
- Who looks after the child
- Parent jobs
What is the definition of school age?
5 years and up
What is given at 12 and 13 months?
- Hib/Men C
- MMR - Measles, mumps and rubella
- PCV - Pneumococcal conjugate
- Men B
If there is sudden onset of painful crying in a child, what would you be thinking about?
- UTI
- Middle ear infection
- Meningitis
- Pain from unrecognised fracture
- Oesophagitis
- Torsion of the testis
What should you do on general examination of an infant when examining the head?
Palpate fontanelles and sutures
How would begin examining a child?
- ABCDE - severity of illness
- General appearence
What should you look for on general examination of a child for respiratory system?
- Cyanosis
- Clubbing of fingers/toes
- Tachypnoea
- Dyspnoea
- Chest shape
What are signs in a child that they are dyspnoeic?
- Nasal flaring
- Grunting
- Use of accessory muscles
- Intercostal/subcostal recession
- Speaking/feeding difficulty
What is clubbing associated with in a child?
- Chronic lung disease - CF
- Cyanotic Heart disease
What are the classic changes in chest shape seen in children?
- Hyperexpansion
- Pectus excavatum/carinatum
- Harrison’s sulci
- Asymmetrical movement
What would localised dullness on percussion in a respiratory exam potentially indicate?
- Consolidation
- Collapse
- Fluid
What would you listen for on ausculatation in a respiratory examination?
- Symmetry
- Hoarse voice
- Stridor
- Breath sounds - vesicular/bronchial
- Wheeze
- Crackles
What would you look for on general examination of the cardiovascular system?
- Cyanosis
- Clubbing
- Pulses
- Resp distress/Pre-cordial bulge
- Ventricular impulse
- Operative scars
What would feel for on palpation of the chest?
- Thrills
- Apex
- RV heave
What would you look for on palpation in a respiratory examination?
- Chest expansion
- Tracheal position
- Apex beat
What is important to asses with regards to pulses on a cardiovascular examination?
Femoral pulses - for coarctation
- May be decreased/impalpable
- Radiofemoral delay
What would you be looking for on auscultation of the cardiovascular system?
- Heart sounds - splitting of second heart sound, third heart sounds
- Murmurs - timing, duration, loudness, site of max intensity, radiation
In a paediatric history, what would you ask on general enquiry?
- General health - active and lively?
- Normal growth
- Pubertal development
- Feeding/drinking/appetite
- Any recent behaviour changes
How would you assess for heart failure on examination?
- Check for heaptomegaly
- Assess pulse - tachy, gallop
- Tachypnoea
How would you gauge the loudness of a systolic murmur?
- 1-2 - soft, difficult to hear
- 3 - easily audible, no thrill
- 4-6 - loud with thrill
