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
2
Q
What does BINDS stand for?
A
BIRTH
IMMUNISATIONS
NUTRITION
DEVELOPMENT
SOCIAL
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
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
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?
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
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.
8
Q
What does HEADSS stand for?
A
HOME
EDUCATION
ACTIVITY
DRUGS/ALCOHOL
SEXUAL HEALTH
SUICIDALITY
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?
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
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
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
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
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
-
End of bed
-
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
- Apex beat
-
Auscultating Heart Sounds
- Apex
- 4 areas
- Murmurs + Added Sounds
- Timing
- Loudness
- Where is it loudest?
- Where does it radiate?
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
-
End of bed
-
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
- Apex beat
-
Auscultating Heart Sounds
- Apex
- 4 areas
- Murmurs + Added Sounds
- Timing
- Loudness
- Where is it loudest?
- Where does it radiate?
21
Q
Talk through pGALS
A
23
Q
Talk through a paediatric neuro examination
A
-
Observation
- Level of Consciousness
- AVPU or GCS
- Playful/Alert
- Level of Consciousness
-
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
