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Child Healthcare Block > Paediatric Hx and Ex > Flashcards

Paediatric Hx and Ex Flashcards

1
Q

What additional sections do we need to add to a paediatric history?

A

Birth Hx
Developmental Hx
Feeding Hx
Vaccination Hx

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2
Q

What do we need to ask in the birth hx?

A
  • Gestational age
  • Weight
  • Complication of pregnancy or delivery
  • Mode of delivery
  • Mode of feeding
  • Amount of care needed after birth
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3
Q

What do we need to ask in the feeding hx?

A
  • How much and how often they eat
  • Do they appear settled after feeding
  • How is their weight progressing
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4
Q

When do infants continue to drink just milk?

A

Up to about 6 months

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5
Q

How much milk should an infant drink a day after birth?

A

150 mls/kg/day.

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6
Q

How long in a day should an infant feed for?

A

10-30 minutes per feed

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7
Q

When should a child be onto solid foods (i.e. chopped up but not mush any more)?

A

One year old

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8
Q

How many times a day should children on solid foods/older children be eating?

A

3 meals a day plus snacks

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9
Q

What, if any, vaccinations are given at birth?

A

BCG for at risk infants

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10
Q

What, if any, vaccinations are given at 2 months?

A

DTP
IPV
HIB
Pneumococcus

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11
Q

What, if any, vaccinations are given at 3 months?

A

DTP
IPV
HIB
Men C

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12
Q

What, if any, vaccinations are given at 4 months?

A

DTP
IPV
HIB
Pneumococcus

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13
Q

What, if any, vaccinations are given at 6 months?

A

None lol, gotcha

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14
Q

What, if any, vaccinations are given at 8 months?

A

None, lol, gotcha again

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15
Q

What, if any, vaccinations are given at 12 months?

A

HIB

Men C

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16
Q

What, if any, vaccinations are given at 13 months?

A

MMR

Pneumococcus

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17
Q

When are pre school boosters given?

A

Age 3/4

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18
Q

What vaccinations are given in secondary school?

A

School leaving boosters including Men C

HPV vaccination

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19
Q

What are the first milestones we look for in a developmental hx?

A

Gross motor skills

20
Q

What are the 4 essential milestones in development?

A

Smiling
Sitting unaided
Walking
Talking

21
Q

When should an infant smile?

22
Q

When should an infant sit unaided?

23
Q

When should a child start to walk?

A

12 months but can be up to 18 months

24
Q

When should a child start to talk?

25
Q

What is a good measure of fine motor skills?

A

The grip a child uses

26
Q

When should a child have developed a mature pincer grip by?

A

10-12 months

27
Q

Name some other things we can use to measure development.

A

Language
Social skills
Special senses

28
Q

A child is refered to you with a cough/difficulty breathing.

Form a list of differentials.

A 
Bronchiolitis
Viral/bacterial LRTI
Croup
Bacterial URTI
Asthma
Foreign body
29
Q

A child is refered to you with a cough/difficulty breathing.

What questions should you ask to narrow down the list of differentials?

A
  • Any secretions?
  • Any temperature (rule infection in or out)?
  • Noise on inspiration or expiration?
  • Pattern? Exposure to new allergens?
30
Q

A child is refered to you with a vomiting.

Form a list of differentials.

A

Pyloric stenosis
Reflux
Gastroenteritis (early if no diarrhoea yet)
Meningitis

Anything really!

31
Q

What is the issue with a child presenting with vomiting?

A

It could really be anything as children often vomit in response to any kind of illness like pain, shock etc.

Need to enquire about every system.

32
Q

Tell me about pyloric stenosis.

A

M>F, may have FHx
Present from around 3-6 weeks after birth.
Presents with spitting up food after eating progressing to projectile vomiting.

33
Q

What do we really need to rule out with vomiting?

A

Meningitis :L !!!!!!!!

34
Q

Why do we ask when the child passed its first stool (meconium) after birth? What is a significant answer?

A

To look for Hirschsprung’s Disease.

If a child has been constipated from birth, and first meconium was passed more than 24 hours after birth.

35
Q

If a child has D+V, what system is most likely the cause?

A

GI

Think gastroenteritis, intersusseption

36
Q

A child presents urinating too frequently.

What is the list of differentials to work through?

A
  • T1DM
  • UTI
  • Psychogenic polydipsia
  • Diabetes insipidus
37
Q

What is a normal amount for a child under the age of 1 to be drinking?

A

100ml/kg/day up to 10kg

38
Q

If we suspect psychogenic polydispsia, what should we ask the parent?

Why?

A

What does the child drink?

psychogenic polydipsia usually drink loads of squash, but if restricted to water they drink a normal amount.

39
Q

If we suspect diabetes insipidus, what should we ask the parent?

Why?

A

What does the child drink?

A child with DI will drink anything to quench the incredible thrist they feel.

40
Q

What are the differentials if a child is not urinating enough?

A 
Obstruction
Dehydration (probably other signs)
41
Q

A mother brings her child to you. He has not passed any urine for a long time.

Form a list of differentials.

A

Retention

Kidney problems

42
Q

A parent brings there child to you with “fits”.

Form a list of differentials for “fits”. Use a surgical seive.

A

Vascular - Vasovagal episode
Infection/Inflamm - Febrile convulsions, Meningitis
Trauma - Head Trauma
(Autoimmune)
Metabolic - Hypoglycaemia, hypernatraemia, hypocalcaemia.
Iatrogenic/Drugs - antidepressants, cocaine, ecstasy, alcohol.
Neoplastic - Brain tumours

Congenital - Hydrocephalus
Degenerative - Neurodegenerative
Endocrine - T1DM/hypoglcaemia
Functional - New onset epilepsy, Pseudoseizures, Breath holding, Self-gratification, Reflux, Night terror.

43
Q

Give me 3 tips for examining a child.

A
  • Dont ask the child if things are ok - gain consent from the parent, then tell the child kindly what you are doing.
  • Auscultate first, or whenever you can. If a child is screaming, you won’t be able to hear a thing.
  • Be on their level - crouch down, or bring them up, and don’t approach too quickly. They might spook.
44
Q

What is different when examining a child compared to an adult?

A

The reference ranges for basic obs.

45
Q

Which obs do we expect to be:

a) lower than in an adult?
b) the same as an adult?
c) higher than in an adult?

A

a) BP
b) Temperature and O2 sats
c) Resp and heart rate

46
Q

In addition to what we do in adults for CVS examination, what do we do for a paeds cvs examination?

A

Feel for the liver, and feel femoral pulses.

47
Q

What is important to note on general inspection of a child at the start of an examination?

A
  • Behaviour and level of awareness
  • Appearance
  • Shape of head and facial features
  • Nature and distribution of skin lesions
  • Any bruising, and if so where it is and what they look like

Child Healthcare Block (17 decks)

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