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Paediatrics > Paediatric Assessment, History Taking and Examination > Flashcards

Paediatric Assessment, History Taking and Examination Flashcards

1
Q

What aspects of the birthing PMH would you want to ask about?

A
  • Gestation
  • Mode of delivery
  • Birthweight
  • Resuscitation required?
  • Birth injury/Malformations
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2
Q

What vaccine can be given annually from age 2-11?

A

Influenza

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3
Q

What is a neonate defined as?

A

<4 weeks old

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4
Q

What can occur within the first few days of life with regard to weight?

A

Babies can lose up to 10% of their initial weight

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5
Q

What would you ask about if there was a suspected neurological problem in a neonate?

A
  • Seizures
  • Attacks
  • Jitters
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6
Q

What is the average weight gain between 9-12 months of life?

A

50-75g/wk

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7
Q

What would you ask if you suspected a neurological problem in an older child?

A
  • Headaches
  • Fits
  • Odd sensation
  • Drowsyness
  • Schooling
  • Vision
  • Hearing
  • Co-ordination
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8
Q

What aspects of the Neonatal PMH would you want to ask about?

A
  • Jaundice
  • Fits/Fevers
  • Bleeding
  • Feeding problems
  • Special care
  • Operations
  • Screening tests
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9
Q

What is the average weight gain within the first 3 months of birth?

A

Approximately 200g/wk

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10
Q

Why do neonates grunt?

A

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

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11
Q

What is the average weight gain between 3-6 months of life?

A

Approximately 150g/wk

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12
Q

What is the average feed volume for children before being weaned onto solids?

A

150ml/kg (140-180 ml/kg)

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13
Q

What are the key components to a full paediatric history?

A
  • PC/HPC
  • PMH
  • Birth History
  • Immunisations
  • Development
  • Drug History and allergies
  • Family history
  • Social History/Personal History
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14
Q

What are general things you want to know about presenting illness in a child?

A
  • When/how did it start?
  • What were they like before?
  • How has it progressed?
  • What makes it worse/better?
  • Feeding issues? - especially infants
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15
Q

What is the average weight gain between 6-9 months of life?

A

Approximately 100g/wk

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16
Q

What would you ask about with in an older child with breathing problems?

A
  • Exercise limitation
  • SOB
  • Cough
  • Wheeze
  • Haemoptysis
  • Chest pain
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17
Q

What are the components of a paediatric history which are not in an adult history?

A
  • In utero/birth/neonatal problems
  • Immunisations
  • Developmental history
  • Personal
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18
Q

If a baby is ill, what can their feed intake drop to?

A

Approximately 100 ml/kg/day

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19
Q

What changes in colour would you potentially ask about?

A
  • Pale - e.g. anaemic
  • Yellow - jaundice
  • Blue - cyanotic heart disease; respiratory distress
  • Red - rash; straining etc.
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20
Q

What would you want to ask about in a vomiting child to help determine a differential?

A
  • Colour - green; yellow etc.
  • Consistency
  • Blood
  • Effort - effortless -> GORD; Projectile -> Pyloric Stenosis
  • Time after feeding
  • How many times/how much
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21
Q

What vaccines are given at 4 months?

A
  • DTaP/IPV/Hib - Diptheria, tetanus, Pertussis, Polio, H. flu B
  • PCV - Pneumococcal conjugate
  • Men B
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22
Q

What would you ask about a childs crying?

A
  • Increased/Decreased
  • Pitch
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23
Q

What would you ask about the stool of a child to help determine a DDx?

A
  • Frequency
  • Size/Shape
  • Consistency
  • Colour
  • Pain when passing
  • Blood/mucus
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24
Q

What is the definition of an infant?

A

<1 year old

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25
Q

What vaccines are given at around 14 years of age

A
  • Td/IPV - Tetanus, diptheria, polio
  • MenACWY
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26
Q

What would you ask about breathing problems in a toddler to determine a DDx?

A
  • Cough
  • Exertional dyspnoea
  • Sputum
  • Haemoptysis
27
Q

What is the definition of a toddler?

A

1-2 years

28
Q

What could you ask about if you suspected there was a GI problem in an older child?

A
  • Appetite
  • D&V
  • Abdominal Pain
  • Stool frequency
  • Rectal Bleeding
  • Weight loss
29
Q

How many grams of feed should a baby be taking in per day?

A

20-30 grams - at spaced intervals

30
Q

What would you ask about the urine in a neonate/toddler to determine a DDx?

A
  • Wet nappies - how often
  • Colour - any blood
  • Smell
  • Output - reduced/stopped
31
Q

What vaccines are given at 2 months?

A
  1. DTaP/IPV/Hib - diptheria, tetanus, pertussis, polio, H. flu B
  2. PCV - Penumococcal conjugate
  3. Men B
  4. Rotavirus
32
Q

What things could you ask about if you suspected a GI problem in a neonate?

A
  • Appetite
  • Diarrhoea
  • Vomiting
  • Jaundice
  • Bleeding/mucus
  • Appropriate weight gain
33
Q

What vaccines are given at 3 years and 4 months?

A
  • DTaP/IPV
  • MMR
34
Q

What vaccine is given to girls age between 12-13 years old?

A

HPV (16+18)

35
Q

What aspects of the PC/HPC would you ask about?

A
  • Colour
  • Activity/floppy/lethargic
  • Feeding
  • Weight gain
  • Vomiting
  • Stools
  • Urine
  • Crying
  • Breathing
  • Not smiling
36
Q

What is the definition of pre-school?

A

2-5 years

37
Q

What would you ask about the urine in an older child?

A
  • Dysuria
  • Haematuria
  • Polyuria
  • Bed wetting
  • Sexual development
  • Thrist
38
Q

What vaccines are given at 3 months?

A
  • DTaP/IPV/Hib - Diptheria, Tetanus, pertussis, Polio, H. flu B
  • Rotavirus
39
Q

What ages are vaccines given at?

A
  • 2 months
  • 3 months
  • 4 months
  • 12-13 months
  • 3 years and 4 months
  • 12-13 - females only
  • 14 years
40
Q

What would you ask about problems with breathing in a neonate to determine a DDx?

A
  • Grunting
  • Wheeze
  • Cyanosis
  • Stridor
41
Q

What aspects of in utero PMH would you ask about?

A

Any problems - abnormal bleeding, medication, alcohol, recreational drugs

42
Q

What would you ask to determine a child developmental history?

A

Ask about ages at which the child learned to do things e.g. sit, crawl, stand, walk etc.

43
Q

What would you ask about if you suspected a neurological problem in a toddler?

A
  • Seizures
  • Drowsyness
  • Hyperactivity
  • Decreased hearing
  • Decreased vision
  • Gait
44
Q

What is the definition of an adolescent?

A

Teenage years (variable depending on time of onset)

45
Q

What would you want to ask about in the Social/Personal History?

A
  • Who is at home?
  • Playing
  • Eating
  • Sleeping
  • Schooling
  • Pets
  • Who looks after the child
  • Parent jobs
46
Q

What is the definition of school age?

A

5 years and up

47
Q

What is given at 12 and 13 months?

A
  • Hib/Men C
  • MMR - Measles, mumps and rubella
  • PCV - Pneumococcal conjugate
  • Men B
48
Q

If there is sudden onset of painful crying in a child, what would you be thinking about?

A
  • UTI
  • Middle ear infection
  • Meningitis
  • Pain from unrecognised fracture
  • Oesophagitis
  • Torsion of the testis
49
Q

What should you do on general examination of an infant when examining the head?

A

Palpate fontanelles and sutures

50
Q

How would begin examining a child?

A
  • ABCDE - severity of illness
  • General appearence
51
Q

What should you look for on general examination of a child for respiratory system?

A
  • Cyanosis
  • Clubbing of fingers/toes
  • Tachypnoea
  • Dyspnoea
  • Chest shape
52
Q

What are signs in a child that they are dyspnoeic?

A
  • Nasal flaring
  • Grunting
  • Use of accessory muscles
  • Intercostal/subcostal recession
  • Speaking/feeding difficulty
53
Q

What is clubbing associated with in a child?

A
  • Chronic lung disease - CF
  • Cyanotic Heart disease
54
Q

What are the classic changes in chest shape seen in children?

A
  • Hyperexpansion
  • Pectus excavatum/carinatum
  • Harrison’s sulci
  • Asymmetrical movement
55
Q

What would localised dullness on percussion in a respiratory exam potentially indicate?

A
  • Consolidation
  • Collapse
  • Fluid
56
Q

What would you listen for on ausculatation in a respiratory examination?

A
  • Symmetry
  • Hoarse voice
  • Stridor
  • Breath sounds - vesicular/bronchial
  • Wheeze
  • Crackles
57
Q

What would you look for on general examination of the cardiovascular system?

A
  • Cyanosis
  • Clubbing
  • Pulses
  • Resp distress/Pre-cordial bulge
  • Ventricular impulse
  • Operative scars
58
Q

What would feel for on palpation of the chest?

A
  • Thrills
  • Apex
  • RV heave
59
Q

What would you look for on palpation in a respiratory examination?

A
  • Chest expansion
  • Tracheal position
  • Apex beat
60
Q

What is important to asses with regards to pulses on a cardiovascular examination?

A

Femoral pulses - for coarctation

  • May be decreased/impalpable
  • Radiofemoral delay
61
Q

What would you be looking for on auscultation of the cardiovascular system?

A
  • Heart sounds - splitting of second heart sound, third heart sounds
  • Murmurs - timing, duration, loudness, site of max intensity, radiation
62
Q

In a paediatric history, what would you ask on general enquiry?

A
  • General health - active and lively?
  • Normal growth
  • Pubertal development
  • Feeding/drinking/appetite
  • Any recent behaviour changes
63
Q

How would you assess for heart failure on examination?

A
  • Check for heaptomegaly
  • Assess pulse - tachy, gallop
  • Tachypnoea
64
Q

How would you gauge the loudness of a systolic murmur?

A
  • 1-2 - soft, difficult to hear
  • 3 - easily audible, no thrill
  • 4-6 - loud with thrill

Paediatrics (27 decks)

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