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Yr 3 Paediatrics > Paediatrics History and Examination > Flashcards

Paediatrics History and Examination Flashcards

1
Q

What are common presenting complaints?

A
  • Headache
  • Ear pain
  • Sore throat
  • Fever
  • Lethargy
  • Not usual self
  • Fit
  • Headache
  • Cough
  • Increased WOB
  • Wheeze
  • Vomiting
  • Abdominal pain
  • Diarrhoea
  • Rash
  • Limp
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2
Q

What does BINDS stand for?

A

BIRTH

IMMUNISATIONS

NUTRITION

DEVELOPMENT

SOCIAL

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3
Q

What does the B in BINDS stand for and what is involved in this?

A

BIRTH

  • Pregnancy
  • Delivery
  • Gestational age
  • Weight
  • Antenatal and postnatal problems
  • Infections
  • Maternal smoking, drug use
  • SCBU
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4
Q

What does the I stand for in BINDS?

A

IMMUNISATIONS

  • Are they up to date?
  • If not, why not?
  • Any extra immunisations outside of normal schedule
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5
Q

What does the N stand for in BINDS?

A

NUTRITION

  • Breast or bottle fed
  • Breast – how long do they feed for and how frequent?
  • Bottle - what formula? how much and how often?
  • Any changes to routine with current problem?
  • Do they have solid diet? If so when was weaning started?
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6
Q

What does the D stand for in BINDS?

A

DEVELOPMENT

  • Stage of development in each area:
    • Gross motor
    • Fine motor and vision
    • Speech, language and hearing
    • Social and emotional
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7
Q

What does the S stand for in BINDS?

A

SOCIAL

  • Family make-up
  • Who lives in the house with the child
  • Parental responsibility
  • Parental occupations
  • Smoking, alcohol and drug usage in home
  • Social services, Health Visitor, professional input
  • Adolescent- H.E.A.D.S.S.
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8
Q

What does HEADSS stand for?

A

HOME

EDUCATION

ACTIVITY

DRUGS/ALCOHOL

SEXUAL HEALTH

SUICIDALITY

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9
Q

Explain what the systemic enquiry is in paediatrics

A
  • Respiratory
    • Apnoea, retractions, nasal flaring, cough
  • Swallowing/Feeding
    • Coughing or choking after eating or drinking
    • Difficulty with bottle/breast feeding
    • How often are they feeding?
  • Cardiovascular
    • Any floppy episodes, cyanosis
  • GI
    • Any vomiting, any constipation or diarrhoea
    • Projectile vomiting
  • GU
    • Any previous UTIs, any daytime or night time wetting (older children)?
    • Number of wet nappies
  • Neurology
    • Any headaches, fits, faints or funny turns? Meeting milestones?
  • Development
    • Regression
    • Delays
  • Joints
    • Any pain, redness or swelling in any joints?
  • Skin
    • Any rashes, changes to skin noted?
  • Vision
    • Any concerns about their vision?
  • Hearing
    • Any concerns about their hearing?
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10
Q

What should you observe for in a paediatric examination?

A
  • Pale/mottled/cool
  • Drowsy
  • Floppy
  • Tachycardic
  • Tachypnoeic
  • Non-blanching rash
  • Bulging fontanelle
  • Grunting/ recession
  • Doesn’t cry with procedures
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11
Q

What are the common presentations and core conditions in the RESPIRATORY bit of the examination?

A

Common Presentation

  • Cough
    • Productive
    • Barking
  • SOB
  • Sore throat
  • Wheeze
  • Stridor
  • Coryzal symptoms

Core Conditions

  • Bronchiolitis
  • Viral Induced Wheeze
  • Asthma
  • Epiglottitis
  • Croup
  • Pneumonia
  • Pertussis
  • Cystic Fibrosis
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12
Q

Talk through a paediatric respiratory examination

A

End of Bed Inspection​

  • Colour, cyanosis​
  • Work of Breathing ​
  • Noisy breathing​
  • Feeding difficulty​
  • Medical equipment​
  • Respiratory distress

Inspection

  • Hands
    • Clubbing (CF)
    • Heart rate (radial in older children, brachial in infant)
    • CRT
  • Mouth
    • Palate (high arched in Marfan/cleft palate)
    • Dental care
    • Cyanosis
  • Chest- Full exposure of the chest is ESSENTIAL
    • Use of accessory muscles
    • Respiratory Rate
  • Palpation
    • Tracheal deviation​
    • On all children​
      • Chest expansion​
      • Cervical lymphadenopathy
  • Percussion ​
    • Rarely useful in children < 2 yrs​
  • Auscultation​
    • Like for like​
    • Start at apex – opportunistic auscultation​
    • Front AND Back​
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13
Q

What are the common presentations and core conditions in the CARDIOVASCULAR bit of the examination?

A

Common Presentations

  • Cough
  • Wheeze
  • Weight Faltering
  • Cyanosis
  • Lethargy
  • Oedema

Core Conditions

  • Congenital Heart Defects
  • Rheumatic Heart Disease
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14
Q

Talk through a paediatric cardiovascular examination

A
  • Inspection
    • End of bed
      • Growth/Feeding
      • Pallor, cyanosis
      • Positioning - squatting
    • Hands
      • Clubbing
    • Face
      • Anaemia
      • Cyanosis
      • Dental hygiene
    • Chest
      • Scars
      • Respiratory distress
  • Palpation
    • Apex beat
      • 4th/5th ICS
    • Thrills
    • Pulses
      • Brachial for infants
      • Radial for >1 yr
      • Femoral
        • Look for radio/brachio-femoral delay
    • Hepatomegaly
    • JVP for older children
  • Auscultating Heart Sounds
    • Apex
    • 4 areas
    • Murmurs + Added Sounds
      • Timing
      • Loudness
      • Where is it loudest?
      • Where does it radiate?
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15
Q

Talk through a paediatric cardiovascular examination

A
  • Inspection
    • End of bed
      • Growth/Feeding
      • Pallor, cyanosis
      • Positioning - squatting
    • Hands
      • Clubbing
    • Face
      • Anaemia
      • Cyanosis
      • Dental hygiene
    • Chest
      • Scars
      • Respiratory distress
  • Palpation
    • Apex beat
      • 4th/5th ICS
    • Thrills
    • Pulses
      • Brachial for infants
      • Radial for >1 yr
      • Femoral
        • Look for radio/brachio-femoral delay
    • Hepatomegaly
    • JVP for older children
  • Auscultating Heart Sounds
    • Apex
    • 4 areas
    • Murmurs + Added Sounds
      • Timing
      • Loudness
      • Where is it loudest?
      • Where does it radiate?
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16
Q

What are the common presentations and core conditions in the GI/GU bit of the examination?

A

Common Presentations

  • Pain
  • Vomiting & Diarrhoea
  • Blood in stool
  • Constipation
  • Weight Faltering
  • Weight gain
  • Fever

Core Conditions

  • GORD
  • Gastroenteritis
  • Constipation
  • Food allergies/ intolerance
  • Pyloric stenosis
  • Intussception
  • UTI
  • Appendicitis
  • Diabetes/DKA
  • Cystic Fibrosis
17
Q

Talk through a paediatric GI/GU examination

A
  • Inspection
    • End of Bed
      • Size/Weight
      • Pain
      • Hydration status
    • Hands
      • Clubbing, palmar erythema
    • Eyes
      • Anaemia/ jaundice
    • Mouth
      • Dental hygiene, mouth ulcers
    • Abdomen
      • Scars, spider navei, distension, masses, peristalsis
  • Palpation
    • Ask where pain is…
    • Start away from pain
    • Make it a game
    • Watch the child’s face
    • Palpable tumours-
      • Wilm’s tumour – doesn’t cross midline
      • Nephroblastoma- crosses midline
    • Assess for peritoneal irritation
      • Blow out tummy/ cough
      • Watch the child walk ‘appendix shuffle’
  • Percussion
  • Auscultate bowel*** ***sounds
  • Other
    • Look in nappy
    • PR not usually done in children
    • Consider urine dip and microscopy
18
Q

What are the common presentations and core conditions in the MSK bit of the examination?

A

Common Presentations

  • Pain
  • Stiffness
  • Swelling
  • Limp
  • Injury
  • Bruising
  • Fever

Core Conditions

  • Trauma
  • NAI
  • Transient Synovitis
  • Septic arthritis
  • Slipped Upper Femoral Epiphysis
  • Perthe’s disease
  • Juvenile arthritis
  • Hip Displasia
19
Q

Talk through a paediatric MSK examination

A
  • General Examination
    • Rashes
    • Muscle wasting
    • Swelling/Deformity
    • Development/Play
  • Joint above and below site of injury/pain
  • Link to development assessment + newborn screening
    • Barlow + Ortolani manoeuvres
  • PGALS
    • For School aged children
  • Screening Questions
    • Pain or Stiffness in muscles/joints/back?
    • Difficulty dressing self?
    • Difficulty going up and down the stairs
20
Q

What are the red flags for an MSK examination?

A
  • Limb preference <18 month
  • Non-weight bearing
  • Impaired internal rotation
  • Warm, red joint
21
Q

Talk through pGALS

22
Q

What are the common presentations and core conditions in the neuro bit of the examination?

A

Common Presentations

  • Delayed developmental milestones
  • Weakness
  • Altered sensation
  • Hearing/ visual changes
  • Headache
  • Poor feeding
  • Seizures

Core Conditions

  • Muscular dystrophies
  • Chromosomal syndromes
  • Cerebral palsy
  • Meningitis
  • ASD
  • Epilepsy
  • Febrile Seizures
23
Q

Talk through a paediatric neuro examination

A
  • Observation
    • Level of Consciousness
      • AVPU or GCS
    • Playful/Alert
  • Ask
    • Any problems with hearing or vision
    • History of developmental delay
    • Presence of birthmarks
  • GCS
  • Inspection
    • Symmetry
    • Muscle bulk
    • Fasciculations
    • Tone
    • Moving all limbs
      • Against gravity
  • PRIMITIVE REFLEXES
  • Reflexes
    • To check…
    • Biceps/Triceps/Brachioradialis
    • Ankle/Knee
    • Plantar
      • Going up may be normal in new-born
      • BUT check is it symmetrical?
    • Usually easy to elicit
    • Hyper-reflexia can be normal
    • Always suspect hypo-reflexia as abnormal
    • Plantar reflex
  • Coordination
    • Finger-nose test- can get to do with eyes shut to assess proprioception
    • Walking
    • Walk on toes, walk on heels, run
    • Balance on one foot, hop
    • Sensation
    • Make into game
    • Can guess where touching
    • Encourage with praise
24
Q

What are the common presentations and core conditions in the ENT bit of the examination?

A

Common Presentation

  • Pain- pulling at ears
  • Sore throat
  • Fever
  • Cough
  • Hearing loss
  • Discharge
  • Neck swelling
  • Delayed speech

Core Conditions

  • Foreign body
  • Acute Otitis Media
  • Mastoiditis
  • Chronic Otitis Media
  • Congenital impaired hearing
  • Adenoidal enlargement
  • Tonsillitis
  • Epiglottitis
25
Q

Talk through a paediatric ENT examination

A
  • Tips
    • Save until last!
    • Do the least painful/normal ear first
  • Positioning
    • Have parent hold child on their lap
      facing the side
    • One arm around body and arms
    • One arm holding head
  • Ask
    • Symptom onset?
    • Observed ingestion/placement
  • Observe
    • Breathing pattern
      • Stridor
    • Anxiety level
    • Developmental stage
  • Throat Examination
    • Look in the mouth
      • Have them roar like a lion
      • Take advantage if they are screaming
    • Look at the back of the mouth and throat
    • May need to apply some pressure.
      • Be gentle and quick.
    • Feel for lymphadenopathy

Yr 3 Paediatrics (7 decks)

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