Paediatric Assessment, History Taking and Examination Flashcards
(64 cards)
1
Q
What aspects of the birthing PMH would you want to ask about?
A
- Gestation
- Mode of delivery
- Birthweight
- Resuscitation required?
- Birth injury/Malformations
2
Q
What vaccine can be given annually from age 2-11?
A
Influenza
3
Q
What is a neonate defined as?
A
<4 weeks old
4
Q
What can occur within the first few days of life with regard to weight?
A
Babies can lose up to 10% of their initial weight
5
Q
What would you ask about if there was a suspected neurological problem in a neonate?
A
- Seizures
- Attacks
- Jitters
6
Q
What is the average weight gain between 9-12 months of life?
A
50-75g/wk
7
Q
What would you ask if you suspected a neurological problem in an older child?
A
- Headaches
- Fits
- Odd sensation
- Drowsyness
- Schooling
- Vision
- Hearing
- Co-ordination
8
Q
What aspects of the Neonatal PMH would you want to ask about?
A
- Jaundice
- Fits/Fevers
- Bleeding
- Feeding problems
- Special care
- Operations
- Screening tests
9
Q
What is the average weight gain within the first 3 months of birth?
A
Approximately 200g/wk
10
Q
Why do neonates grunt?
A
Increased air pressure against a partially closed glottis - similar effect to pursed lipped breathing in COPD patients -> opens easily collapsible airways due to back pressure
11
Q
What is the average weight gain between 3-6 months of life?
A
Approximately 150g/wk
12
Q
What is the average feed volume for children before being weaned onto solids?
A
150ml/kg (140-180 ml/kg)
13
Q
What are the key components to a full paediatric history?
A
- PC/HPC
- PMH
- Birth History
- Immunisations
- Development
- Drug History and allergies
- Family history
- Social History/Personal History
14
Q
What are general things you want to know about presenting illness in a child?
A
- When/how did it start?
- What were they like before?
- How has it progressed?
- What makes it worse/better?
- Feeding issues? - especially infants
15
Q
What is the average weight gain between 6-9 months of life?
A
Approximately 100g/wk
16
Q
What would you ask about with in an older child with breathing problems?
A
- Exercise limitation
- SOB
- Cough
- Wheeze
- Haemoptysis
- Chest pain
17
Q
What are the components of a paediatric history which are not in an adult history?
A
- In utero/birth/neonatal problems
- Immunisations
- Developmental history
- Personal
18
Q
If a baby is ill, what can their feed intake drop to?
A
Approximately 100 ml/kg/day
19
Q
What changes in colour would you potentially ask about?
A
- Pale - e.g. anaemic
- Yellow - jaundice
- Blue - cyanotic heart disease; respiratory distress
- Red - rash; straining etc.
20
Q
What would you want to ask about in a vomiting child to help determine a differential?
A
- Colour - green; yellow etc.
- Consistency
- Blood
- Effort - effortless -> GORD; Projectile -> Pyloric Stenosis
- Time after feeding
- How many times/how much
21
Q
What vaccines are given at 4 months?
A
- DTaP/IPV/Hib - Diptheria, tetanus, Pertussis, Polio, H. flu B
- PCV - Pneumococcal conjugate
- Men B
22
Q
What would you ask about a childs crying?
A
- Increased/Decreased
- Pitch
23
Q
What would you ask about the stool of a child to help determine a DDx?
A
- Frequency
- Size/Shape
- Consistency
- Colour
- Pain when passing
- Blood/mucus
24
Q
What is the definition of an infant?
A
<1 year old
25
What vaccines are given at around 14 years of age
* **Td/IPV** - Tetanus, diptheria, polio
* **MenACWY**
26
What would you ask about breathing problems in a toddler to determine a DDx?
* **Cough**
* **Exertional dyspnoea**
* **Sputum**
* **Haemoptysis**
27
What is the definition of a toddler?
1-2 years
28
What could you ask about if you suspected there was a GI problem in an older child?
* **Appetite**
* **D&V**
* **Abdominal Pain**
* **Stool frequency**
* **Rectal Bleeding**
* **Weight loss**
29
How many grams of feed should a baby be taking in per day?
***_20-30 grams_*** - at spaced intervals
30
What would you ask about the urine in a neonate/toddler to determine a DDx?
* **Wet nappies** - how often
* **Colour** - any blood
* **Smell**
* **Output** - reduced/stopped
31
What vaccines are given at 2 months?
1. **DTaP/IPV/Hib** - diptheria, tetanus, pertussis, polio, H. flu B
2. **PCV** - Penumococcal conjugate
3. **Men B**
4. **Rotavirus**
32
What things could you ask about if you suspected a GI problem in a neonate?
* **Appetite**
* **Diarrhoea**
* **Vomiting**
* **Jaundice**
* **Bleeding/mucus**
* **Appropriate weight gain**
33
What vaccines are given at 3 years and 4 months?
* **DTaP/IPV**
* **MMR**
34
What vaccine is given to girls age between 12-13 years old?
HPV (16+18)
35
What aspects of the PC/HPC would you ask about?
* **Colour**
* **Activity/floppy/lethargic**
* **Feeding**
* **Weight gain**
* **Vomiting**
* **Stools**
* **Urine**
* **Crying**
* **Breathing**
* **Not smiling**
36
What is the definition of pre-school?
2-5 years
37
What would you ask about the urine in an older child?
* **Dysuria**
* **Haematuria**
* **Polyuria**
* **Bed wetting**
* **Sexual development**
* **Thrist**
38
What vaccines are given at 3 months?
* **DTaP/IPV/Hib -** Diptheria, Tetanus, pertussis, Polio, H. flu B
* **Rotavirus**
39
What ages are vaccines given at?
* **2 months**
* **3 months**
* **4 months**
* **12-13 months**
* **3 years and 4 months**
* **12-13** - females only
* **14 years**
40
What would you ask about problems with breathing in a neonate to determine a DDx?
* **Grunting**
* **Wheeze**
* **Cyanosis**
* **Stridor**
41
What aspects of in utero PMH would you ask about?
**Any problems** - abnormal bleeding, medication, alcohol, recreational drugs
42
What would you ask to determine a child developmental history?
Ask about ages at which the child learned to do things e.g. sit, crawl, stand, walk etc.
43
What would you ask about if you suspected a neurological problem in a toddler?
* **Seizures**
* **Drowsyness**
* **Hyperactivity**
* **Decreased hearing**
* **Decreased vision**
* **Gait**
44
What is the definition of an adolescent?
Teenage years (variable depending on time of onset)
45
What would you want to ask about in the Social/Personal History?
* **Who is at home?**
* **Playing**
* **Eating**
* **Sleeping**
* **Schooling**
* **Pets**
* **Who looks after the child**
* **Parent jobs**
46
What is the definition of school age?
5 years and up
47
What is given at 12 and 13 months?
* **Hib/Men C**
* **MMR -** Measles, mumps and rubella
* **PCV** - Pneumococcal conjugate
* **Men B**
48
If there is sudden onset of painful crying in a child, what would you be thinking about?
* **UTI**
* **Middle ear infection**
* **Meningitis**
* **Pain from unrecognised fracture**
* **Oesophagitis**
* **Torsion of the testis**
49
What should you do on general examination of an infant when examining the head?
Palpate fontanelles and sutures
50
How would begin examining a child?
* **ABCDE** - severity of illness
* **General appearence**
51
What should you look for on general examination of a child for respiratory system?
* **Cyanosis**
* **Clubbing of fingers/toes**
* **Tachypnoea**
* **Dyspnoea**
* **Chest shape**
52
What are signs in a child that they are dyspnoeic?
* **Nasal flaring**
* **Grunting**
* **Use of accessory muscles**
* **Intercostal/subcostal recession**
* **Speaking/feeding difficulty**
53
What is clubbing associated with in a child?
* **Chronic lung disease - CF**
* **Cyanotic Heart disease**
54
What are the classic changes in chest shape seen in children?
* **Hyperexpansion**
* **Pectus excavatum/carinatum**
* **Harrison's sulci**
* **Asymmetrical movement**
55
What would localised dullness on percussion in a respiratory exam potentially indicate?
* **Consolidation**
* **Collapse**
* **Fluid**
56
What would you listen for on ausculatation in a respiratory examination?
* **Symmetry**
* **Hoarse voice**
* **Stridor**
* **Breath sounds** - vesicular/bronchial
* **Wheeze**
* **Crackles**
57
What would you look for on general examination of the cardiovascular system?
* **Cyanosis**
* **Clubbing**
* **Pulses**
* **Resp distress/Pre-cordial bulge**
* **Ventricular impulse**
* **Operative scars**
58
What would feel for on palpation of the chest?
* **Thrills**
* **Apex**
* **RV heave**
59
What would you look for on palpation in a respiratory examination?
* **Chest expansion**
* **Tracheal position**
* **Apex beat**
60
What is important to asses with regards to pulses on a cardiovascular examination?
**Femoral pulses - for coarctation**
* May be decreased/impalpable
* Radiofemoral delay
61
What would you be looking for on auscultation of the cardiovascular system?
* **Heart sounds** - splitting of second heart sound, third heart sounds
* **Murmurs** - timing, duration, loudness, site of max intensity, radiation
62
In a paediatric history, what would you ask on general enquiry?
* **General health** - active and lively?
* **Normal growth**
* **Pubertal development**
* **Feeding/drinking/appetite**
* **Any recent behaviour changes**
63
How would you assess for heart failure on examination?
* **Check for heaptomegaly**
* **Assess pulse** - tachy, gallop
* **Tachypnoea**
64
How would you gauge the loudness of a systolic murmur?
* **1-2** - soft, difficult to hear
* **3** - easily audible, no thrill
* **4-6** - loud with thrill
