Paediatric History & Examination Flashcards

1
Q

Outline the different sections of paediatric history

A
  • Introduction
  • Hx presenting complaint
  • Systems review (intake, output, vomiting, fever, rash, weight, behaviour etc…)
  • PMH, medications & allergies
  • Antenatal history (pregnancy complications, medications/drugs etc in pregnancy, birth, premature/term, weight, complications)
  • Developmental history
  • Immunisation history
  • ICE
  • Family history
  • Social history (who live with, happiness at home/school, smoking status at home, pets at home)
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2
Q

When talking to an adolescent/young adult you important to address health risk behaviours that are more prevalent in this population. Use the HEEADSSS acronym to highlight key areas to discuss

A
  • Home & relationships
  • Education & employment
  • Eating
  • Activities & hobbies
  • Drugs, alcohol, tobacco
  • Sex & relationships
  • Self-harm, depression, self-image
  • Safety & abuse
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3
Q

You may do a specific system examination on a child (e.g. abdo exam) or you may just be asked/required to examine a child. Outline how you would perform a general examination of a child

A
  • General inspection of child
  • General inspection of surroundings
  • Hands/wrists: inspect hands, check CRT, check temp, HR, RR
  • Head: eyes (jaundice, anaemia), mouth, ears, cervical lymph nodes
  • Chest: assess WOB, central CRT, auscultate for heart & lung sounds, do other aspects of resp/cardio if think relevant
  • Abdo: palpate all quadrants, feel for organomegaly, listen to bowel sounds (anything else think relevant)
  • Legs & everything else: check for any rashes, cuts etc…
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4
Q

When is the NIPE performed?

A
  • 72hrs after birth
  • Repeated at 6-8 weeks by GP
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5
Q

Outline steps of NIPE

A
  • Introduction & general questions
  • General appearance
  • Head
  • Shoulders & arms
  • Chest
  • Abdomen
  • Genitals
  • Legs
  • Back
  • Reflexes
  • Others/investigations/obs (weight, length, OCP if not done in head, pre & post ductal saturations, RR, HR)
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6
Q

How do you want baby for NIPE?

A

Stripped down to nappy

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7
Q

What should you ask in the general questioning at start of NIPE?

A
  • Ask parent if they have any concerns
  • Ask briefly about pregnancy & birth (complications)
  • Has baby passed meconium?
  • Is baby feeding okay?
  • FH of congenital heart, eye or hip problems?
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8
Q

What should you assess in general examination section of NIPE?

A
  • Colour (pallor, cyanosis, jaundice)
  • Tone
  • Activity
  • Cry
  • Obvious abnormalities (e.g. malformations, syndromic appearances)
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9
Q

What should assess in the head section of the NIPE?

A
  • General appearance of head & face (shape, injury, syndromic appearance)
  • Feel head (caput succedaneum, cephalohematoma, overriding sutures, anterior fontanelle)
  • Occipitofrontal circumference (OCP)
  • Inspect ears (patent, low set, asymmetry, skin tags)
  • Inspect eyes (epicanthic folds in Down’s, erythema & discharge, subconjunctival haemorrhage, fundal/red reflex, cataracts)
  • Inspect nose (patent)
  • Inspect mouth (cleft lip, cleft palate & sucking reflex, ankyloglossia)
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10
Q

What should you assess in the shoulders & arms section of the NIPE?

A
  • Inspect neck (webbing, lumps)
  • Shoulder symmetry (clavicle fractures)
  • Arms (position & movement e.g. Erb’s palsy)
  • Brachial pulses
  • Palmar creases
  • Digits (number, clinodactyly)
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11
Q

What should you assess in the chest section of the NIPE?

A
  • Observe breathing (distress, asymmetry, listen for grunting or stridor)
  • Auscultate heart sounds
  • Auscultate lungs
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12
Q

What should you assess in the abdomen section of the NIPE?

A
  • Shape (concave may indicate diaphragmatic hernia)
  • Umbilical stump (discharge, infection, hernia)
  • Palpate abdomen
  • Auscultate bowel sounds
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13
Q

What should you assess in the genitals section of the NIPE?

A
  • Femoral pulses
  • General inspection of genitalia (ambiguity, obvious abnormalities)
  • Palpate testes & scrotum (undescended testes, hernias, hydrocoele)
  • Inspect penis (hypospadias, epispadias)
  • Inspect anus (patent)
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14
Q

What should you assess in the legs section of the NIPE

A
  • Inspect legs (equal movements, skin creases, tones, talipes)
  • Examine hips (Barlow’s & Ortolani’s)
  • Inspect toes (count number)
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15
Q

What should you assess in the back section of the NIPE?

A
  • General inspection (curvature, hair, pilonidal sinus)
  • Feel for spinous processes
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16
Q

What reflexes should you assess in the reflexes section of the NIPE?

A
  • Moro reflex: when rapidly tipped backwards the arms and legs will extend
  • Suckling reflex: placing a finger in the mouth will prompt them to suck
  • Rooting reflex: tickling the cheek will cause them to turn towards the stimulus
  • Grasp reflex: placing a finger in the palm will cause them to grasp
  • Stepping reflex: when held upright and the feet touch a surface they will make a stepping motion
17
Q

What should you be looking for on skin when doing NIPE?

A
  • Haemangiomas
  • Port wine stains
  • Mongolian blue spot
  • Cradle cap
  • Desquamation
  • Erythema toxicum
  • Milia
  • Acne
  • Naevus simplex (“stork bite”)
  • Moles
  • Transient pustular melanosis
18
Q

What should do in the others/investigations/obs section of the NIPE?

A
  • Weight
  • Length
  • OCP (if not done in head)
  • RR
  • Pre & post ductal saturations (pre on right hand, post on either leg)
  • HR
19
Q

What should you do after you have finished the NIPE?

A
  • Discuss any abnormalities with senior
  • Share any findings with parents
  • Document examination in NIPE computer system and baby’s red book
  • Ask parent if have any questions
  • Make any relevant referrals