Paediatric History/Exam Flashcards
Additional things to ask in paediatric history (BINDS)
Birth Immunisations Nutritrion/feeding Development Social history in detail, including School, Siblings, Smoking (parents), Salaries (parents' jobs), and Social services input.
Paediatric systems review.
a) CV
b) Resp
c) ENT
d) GI/GU
e) Derm/MSK
f) Neuro
g) Other (WAFFLES)
Cardio: cold sweats, turning blue.
Resp: cough, wheeze/stridor, coryza.
ENT: earaches/discharge, sore throat.
GI and GU: peeing (wet nappies? enuresis, day or night?), pooing, eating, drinking.
Derm and MSK: rashes, swollen/stiff joints.
Neuro: fits, faints, funny turns.
Systemic, WAFFLES: Weight, Appetite, Fever, Feeding, Lumps, Energy/mood/crying, School absences/sleep disturbance
Paeds medications
- remember to ask about _____ and _______.
Creams and inhalers
Birth history.
a) Pregnancy - 3 questions
b) Birth - 3 questions
c) Postnatal - 2 questions
Pregnancy: complications, mum on drugs (recreational and medical), multiple gestation?,
Birth: where (home/hospital), when (term?), and how (vaginal/caesarean),
Health: birth weight, SCBU, infections or early ABx use, prolonged jaundice, birth marks? (e.g. cafe au lait spots)
Developmental.
a) Ask about _____ and ______ (request chart)
b) Any problems at…?
c) 4 domains - question for each
Ask about height and weight; growth chart.
Problems at school?
Specifically ask about problems in the 4 developmental domains: gross motor (e.g. sitting, walking), fine motor and vision (e.g. pincer grip), speech and hearing (e.g. hearing assessment), and social, emotional and behavioural
Paediatric obs (HR, RR, SBP)
a) <1yr
b) 1-2
c) 2-5
d) >5
Normal ranges for obs
HR, RR, SBP:
0-1 year: 110-160 bpm, 30-40 resps, 70-90 mmHg.
1-2 years: 100-150 bpm, 25-35 resps, 75-95 mmHg.
2-5 years: 95-140 bpm, 20-30 resps, 80-100 mmHg.
5-12 years: 80-100 bpm, 15-20 resps, 90-110 mmHg.
Heart failure in infants.
a) 5 symptoms
b) 5 signs
a) Poor feeding, breathlessness, blue episodes, FTT, tiredness, appear unwell
b) Tachycardia, tachypnoea, poor peripheral pulses, hypoxia, hepatomegaly
Causes of clubbing.
CL(ABCDEF)UBBING
C yanotic heart disease L ung diseases: Abscess, Bronchiectasis, Cystic fibrosis, Don’t say COPD!!!!, Empyema, Fibrosis U lceratice colitis + Crohn’s (Inflammatory bowel diseases) B iliary cirrhosis B irth defect I nfective endocarditis N eoplasm (Lung Ca, mesothelioma) G I malabsorption (Coeliac disease)
Factors increasing likelihood of asthma-induced wheeze (versus other causes of wheeze)
DR. BANT
Dry cough (acoryzal) Recurrent/persistent (>4 weeks) Bronchodilator response Atopy (eczema, allergies, urticaria) Nocturnal cough Triggers (cold, laughter, pets, exercise)
Acute asthma
a) < 2 years old - SpO2 cutoff for severe? Other features that are important?
b) > 2 years old - cutoff for severe? Other features that are important?
a) 92%; feeding, respiratory distress, cyanosis
b) 92%; HR/RR, PEFR, cyanosis, respiratory distress, agitation, coma, silent chest, poor respiratory effort
Health visitor check at 2 - 2.5 years old:
a) Early identification of…?
b) Ensure high ______ rates.
c) Provide information on….?
d) Other checks from newborn to HV check
a) Developmental delay; obesity; psychosocial/ parenting issues
b) Immunisation
c) Dental care, toilet training, healthy eating, parenting tips
d) The neonatal examination. The new baby review (around 14 days old). The baby’s 6- to 8-week examination. By the time the child is 1 year old.
Health visitor check: developmental milestones by age 2 - 2.5:
a) Gross motor
b) Fine motor
c) Speech and language
d) Social and emotional
a) Walking and running without falling, ability to walk up or down at least two steps, Jumping, Kicking a ball.
b) Stack seven or more blocks, thread beads or pasta on a string, Imitating a drawing of a line, Ability to use a turning motion for doorknobs, lids, wind-up toys.
Ability to turn switches on and off, Ability to turn pages in a book.
c) Following instructions (eg, “get your book” or “close the door”. Vocabulary: Ability to name items/animals in a picture or parts of the body. Words such as “mine”, “you”, “me”. Understanding instructions given without gestures/pointing. Ability to make sentences of 3-4 words. Intelligible to familiar adults. Parent noticed issues with hearing?
d) Copying gestures. Ability to use cutlery. Appropriate play with common toys. Ability to put on a coat without help. Calling themselves “I” or “me”.
Developmental red flags.
a) GM
b) FM
c) S, L+H
d) S+E
e) Other red flags
a) Not sitting by 12m, not walking by 18m
b) Hand preference before 18m
c) No clear words by 18m
d) No interaction with carers by 2m, not smiling by 3m, no interest playing with peers by 3 years. Doesn’t play pretend or make-believe. Doesn’t make eye contact
e) - REGRESSION (think SMA)
- Poor health/growth
- Findings o/e (microcephaly, dysmorphic fx)
- Safeguarding issues
Gross motor milestones.
a) Newborn,
b) 3m, 6m, 9m, 12m
c) 18m (latest), 2y, 3y, 4y, 5y
d) What should be checked in boys not walking by 18m?
a) Normal symmetrical movements
b) 3m - Lifts head up when on tummy; 6m - sits unsupported; 9m - pulls to stand; 12m - stands/ starts to walk
c) 18m - Walks (probably well); 2y - 2 steps; 3y - jumps; 4y - hops; 5y - rides bike
d) CK levels for DMD - assess for Gower sign
Fine motor and vision milestones (grasp, drawing, cubes)
a) 6 weeks
b) 9 months
c) 1 year
d) 2 years
e) 3 years
f) 4 years
a) 6wk - Follows finger 90 degrees
b) 9m - Pincer grip of cube in each hand
c) 1y - Scribble (palmar grasp)
d) 2y - Tower of 2 cubes; copies line
e) 3y - Tower of 8 cubes (2 cubed); copies circle
f) 4y - Copies square (4 sides)
