PEDIATRICS 1: Data Gathering & Presentation (History Taking and Physical Examination)

Flashcards covering key concepts from Pediatrics 1 lectures on Data Gathering & Presentation, including History Taking and Physical Examination.

What is the primary role of history taking in pediatric medicine?

History taking is essential for the physician to make a correct diagnosis and forms the backbone of clinical practice.

How does pediatric history taking differ from adult history taking?

Pediatric history includes prenatal and birth history, developmental history, socio-history of family-environmental risks, immunization history, and feeding history.

Who is the primary source of clinical information in pediatric history taking?

Information is usually obtained indirectly from parents or guardians, rather than directly from the patient, especially if the child is unable to express themselves.

What percentage of cases can be diagnosed effectively with a good pediatric history?

A good pediatric history can provide enough information to make a diagnosis in around 80% of cases.

How should an interviewer approach adolescents during history taking?

In adolescents, focus the interview on them and demonstrate genuine interest in them (rather than just their problems) to encourage them to open up.

What information is included in the 'General Data' section of a pediatric history?

General Data includes the patient's full name, age (in months/days for neonates), sex, birthdate, birthplace, present address, number and date of hospital admission, name of hospital admitted, name of informant and relation to the patient, reliability of informant, and religion.

How is the reliability of an informant recorded?

Reliability is recorded as poor, fair, or good percentage, depending on factors such as hours spent with the patient, educational attainment, and involvement in patient care.

What is the 'Chief Complaint' in pediatric history taking?

The Chief Complaint is the most important symptom that prompted the consultation, expressed in a word or two without diagnostic terms or names of diseases, using the informant's exact words whenever possible.

What is the difference between signs and symptoms?

Symptoms are what the patient feels, while signs are what the doctor sees during a physical examination.

What percentage of differential diagnoses can a good History of Present Illness (HPI) yield?

A good HPI can yield up to 80% of differential diagnoses.

How should signs and symptoms be described in the HPI?

Signs and symptoms should be described in chronological order, noting their onset, time, manner, and severity (using specific numbers of hours, days, weeks, or months).

What are the 'Seven Attributes of a Symptom' used for elaboration in HPI?

The seven attributes are Location, Quality, Quantity or Severity, Timing, Onset, Remitting or exacerbating factors, and Associated manifestations.

What are the definitions of Acute, Sub-acute, and Chronic illness duration?

Acute is less than 7 days, Sub-acute is less than 7 days but not less than 2 days, and Chronic is greater than 7 days.

What information should be recorded for medications in the HPI?

Both generic and brand names (ideally generic), actual dose (mg/kg/dose or mg/kg/day), and duration of treatment should be recorded.

What are pertinent negatives in HPI and why are they important?

Pertinent negatives are statements of symptoms that were absent but could be related to the potential differential diagnoses. They are important for ruling in or out possible differentials.

What is the purpose of the 'Review of Systems' (ROS) in pediatric history taking?

The ROS helps uncover symptoms in other body systems not covered in the HPI that may be related to or accompany the present illness, and questions should be age-appropriate.

What distinct information is included in 'Maternal-Obstetrical History'?

This section covers the age of the mother during pregnancy, parity, gravida, mother's health and nutrition during pregnancy, infections, drug intake, radiation exposure, and duration of gestation.

What key information is included in 'Birth History'?

Birth History includes term pregnancy (preterm, term, postterm), manner of delivery (SVD or CS), APGAR score, person who attended the delivery, and birth weight.

Why is birth weight important in pediatric history?

Birth weight and gestational weight are important for predicting clinical problems and morbidity.

What is the definition of the 'Neonatal period'?

The neonatal period spans the first 28 days after birth, further subdivided into very early (birth to <24 hours), early (birth to 7 days), and late (8-28 days).

What are the definitions for Preterm, Term, and Postterm gestational age?

Preterm is before 37 weeks, Term is 37-41 & 6/7 weeks, and Postterm is after 42 weeks.

When does jaundice become clinically apparent in a newborn?

Jaundice becomes clinically apparent when serum bilirubin concentration is ">=5 mg/dL.

List some common types of jaundice found in the neonatal period.

Physiologic jaundice, breastfeeding-associated jaundice, breastmilk jaundice syndrome, ABO incompatibility, and Rh incompatibility are common types.

What are some common infections seen during the neonatal period?

Common neonatal infections include neonatal sepsis, necrotizing enterocolitis, transplacental infections (e.g., toxoplasmosis, rubella, CMV, herpes simplex), as well as various viral and bacterial infections.

What causes neonatal seizures?

Neonatal seizures can be caused by intracranial hemorrhage, metabolic disturbances (e.g., hypernatremia, hyponatremia, hypocalcemia), infections, drug withdrawal, and other factors like inadvertent injection of anesthetics during delivery.

What information is obtained in the 'Nutritional History' for infants?

For infants, nutritional history includes types of feeding (breastfed, bottle-fed, formula used), demand or scheduled feeding, vitamins (type, dose), fruit juice intake, and introduction of solids.

What is the recommendation for fruit juice intake in infants and toddlers?

Juices should not be given before 12 months of age. Limited to 4 oz/day for 1-3 years, 4-6 oz/day for 4-6 years, and 8 oz/day for 7-18 years.

What is the recommended daily caloric intake for infants?

Infants require 100 kcal/kg/day.

What are the four main developmental domains focused on for younger children in 'Growth and Development' appraisal?

The four main developmental domains are gross motor, fine motor, language (expressive, receptive), and personal and social.

What is the HEEADSSS interview and who is it used for?

HEEADSSS is a psychosocial risk assessment instrument used for identifying high-risk adolescents (10-20 years old). It stands for Home Environment, Education & Employment, Eating, peer related Activities, Drugs, Sexuality, Suicide/Depression, Safety from injury and Violence, and Spirituality.

What are some concerning signs that a patient may be dealing with depression or negativity?

Signs include isolating oneself and having no friends.

What social media usage time frame is considered concerning for pediatric patients?

Spending more than 120 minutes per day on social media sites and/or applications is considered a concerning response.

What information should be checked when inquiring about 'Immunization' history?

Check the types of immunization given, age when given, untoward reactions, and number of doses administered. Refer to the recommended immunization schedule based on age.

What is the route and schedule for the primary dose of BCG vaccine?

BCG is given Intradermally (ID) after birth, preferably within 2 months of life.

What is the route and schedule for the primary doses of Hepatitis B vaccine?

Hepatitis B is given Intramuscularly (IM): 1st dose ">=2 kgs within 24 hours of life; 2nd dose 1-2 months after 1st dose; 3rd dose not earlier than 24 weeks of age.

What details should accompany contracted illnesses in 'Past Medical History'?

State the age when contracted, severity, and complications. Include resolution or ongoing issues, medications, and relevant surgical conditions, allergies, injuries, or hospitalizations.

What information regarding parents and siblings is included in 'Family History'?

For parents, age, occupation, and state of physical/mental health; if not living, age and cause of death. For siblings, number, ages, and state of health; if not living, age and cause of death.

When is a genogram drawn in 'Family History'?

A genogram is drawn if the existence of a genetic anomaly is suspected, with sensitivity regarding the information.

What aspects are covered under 'Living Circumstances' in a Personal, Social, and Environmental History?

Living circumstances include the place and nature of dwelling, number of persons living inside the house, garbage disposal, and presence of pets.

How should the physical examination approach differ for young children compared to adults?

The usual order for adults is often not appropriate for young children; it is best to leave the more unpleasant or uncomfortable parts of the examination to the last, varying with the child's age and situation.

What is the general sequence for abdominal examination?

The general sequence for abdominal examination is Inspection, Auscultation, Palpation, and Percussion (IAPP).

When can a rectal examination be deferred in a child?

A rectal examination can be deferred unless it is relevant to the child's illness.

How is height measured for children under 2 years old?

For children under 2 years old, height is measured in a supine position to straighten the back, as their posture is predominantly still lordotic.

What landmarks are used for measuring head circumference?

Head circumference is measured using the glabella, just above the ear, and the occiput.