Paediatric Examination BW3 Flashcards
What are major differences in Paediatric examination vs adults:
Paed exam outline and what you need? (differences e.g chaperone)
Outline a thorough paediatric history with relevant additions specific for paeds:
General paed examination process: outline:
General inspection? Dysmorphic features? Anthropometry? Vs? Examine painful system last
Outline paediatric respiratory examination:
General appearance? Abnormal breathing? Cyanosis? Character of cough? Hands? Face? Trachea?
Respiratory examination:
Chest continued:
Inspection, palpation, percussion, auscultation, abdomne, other special (resp-pembertons)
What side of the bed must you always examine from?
Right side
General inspection: Outline all finding? Examination
General observation of conciousness: AVPU:
A
V
P
U
What does it mean?
What comes after vitals on all paed exams?
Anthropometry: Outline what needs to be measured
- Weight
- height
- head circumference
- Always plot on percentiles!!!
What are bedside respiratory tests that can be completed in children:
Outline the procudre of weighing a baby?
Outline how to correctly take height (paed exam)
Taking a paediatric patients (length) Usually patients under 2
Guide to accuratley take length: Paed
(some children can never take height, e.g cerebal palsy children always need length)
Head cirumference: Done routine until 2 years: Outline how to be completed
Outline causes of increased HC (outside percentile)
Need to do every case
Outline paediatric examination:
General appearance:
Hands:
VS/Pulse:
Face, Neck
How and where do you plot paediatric anthropometry?
What do you need to do if patient was born premature?
What charts are used in QLD for under 2? over 2 years?
Continued: CVS examination: OUtline praecordium examination:
Inspection, palpation, percussion, auscultation:
Plot the following:
Gender?
Full term, dob, weight measurements
Plot the following: Read
How to plot for premature birth and percentile charts:
Premature charts- when become normal age 0- can use normal
WHO charts premature charts
What must you do?
Always need to write on bottom, born at 34 weeks corrected for 6 weeks prematurity:
Example plot: Premature child:
Vital signs in paediatrics:
What is a CEWT? (childrens early warning tool)
Early warning pick up: Age corrected VS ranges: Gives score when VS outside normal: Then gives management - needs to be reviewed
RR
02
Temp
HR
Bp
CRT central and peripheral?
How do we measure temperature in children
What is a different with VS - Especially Pulse: Feels for femoral also!!!!rate, rhytmn
Paeds CVS examination:
Vital signs: BP in paeds: RCH hypertension guidelines for boys: > 90th percentile =HTN!
Systems examination: Paediatrics:
We usually examine all systems:
CVS, Abdo, ENT (last) always include LN examine in any infection!
Outline General approach to all system examinations: General:
PAediatrics respiratory examination:
Outline: Whats different?
General inspection? WOB? Use of accessory muscles) (nasal flaring, head bobbing, tracheal tug) LOC? Irratability, breathing pattern?
Read resp examination PAG:
Respiratory history: Paediatrics:
Outline important areas to cover
Paed resp exam: General observations? Audible noises?
Paed hands exam resp: Outline:
Respiratory exam: Face-
Outline:
+ ENT+LN (infections)
Respiratory examination: General observation outline what looking for:
Whats Harrisons sulcus?
Flaring of the lower edge of the rib cage seen in poorly controlled asthma
Paeds resp: Palpation: Outline
Assess: Tracheal tug, expansion, vocal fremitus (only if can speak+cooperate)
Resp examination: Percussion: Outline findings:
Paeds Resp examination: Auscultation:
Outline-
How do you outline your findings? WHat three things must be explained?
Note need to examine abdomen for liver/ent/cervical lymph nodes in resp paed exam!
Paediatric respiratory history key questionsPAG:
CVS examination:
Paeds: Outline General inspection on CVS:
What will you look for? VS, Anthro
PAed CVS exam: What must you always do!
Hands? Skin? Face, mouth? Neck?
Paeds resp exam: outline
Paed CVS exam:
Inspection of chest wall?
Palpation of chest? outline
Praecordial examination: Outline steps: (lecture)
Paeds: CVS examination:
Auscultation: Outline how to expain:
How to define and explain murmur?
Outline “CARDIO”
Murmurs: Types?
Grading? Examination of back? Examination for PVD
CVS: Signs of heart failure:
Signs list 6?
CVS: Examination PAG
Key systematic CVS history questions:
Breathlessness
HX keypoints read
Paediatric GI examination:
Preamble?
General inspection: List key findings to look for
Paed Abdo exam: Lecture:
General inspection: Continued read
Paeds GI:
VS+anthropometry
Hands?
Outline what your looking for
GI Paeds:
Arms
Skin
FAce
Outline findings:
GI exam: Observation of abdomen:
Outline what your looking for?
4 quadrants used in paeds:
Paed GI: Palpation: Outline
How to make it successful?
Palpation of GI system in paeds continued:
What are you looking for on deep palpation?
If you find tenderness in GI paed exam:
How do you further work out tenderness and location?
Could ask to cough?
Or to Jump?
Paed GI exam:
Deep palpation of organs: Examine which organs? Start where? What are you looking for?
GI Exam: Percussion:
What is different? WHat looking for?
Percussion Paeds GI exam:
key points
and bowel sounds?
GIT: Special feature:
Always look under the nappy!
What else is important? List? Testes? Hypospadias, hernias
GI Exam:
Legs, buttocks, peripheries?
What are buttoc signs:
Question MCQs;
read
MCQ
read
FALSE
MCQ
Fals: Central better
MCQ
How is HTN defined in children?
GI Exam assessment: PAG read
GI Exam:
key questions on history: Read PAG
Paediatric ENT: examination:
Most important is safety
Get mother to hold pts head
Turn baby around, one arm secures head against parents chest to examine ear:
Throat examination: Of child key tips:
Have child sitting on parents lap
Have tongue depressor ready
Tell parent to hold across chest, and across forhead, examine throat quickly
Summary hx and examination of ENT: and all system:
In summary: Writing up your findings:
What must always be done in paed exam”
Whats important in acute presentation:
