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Prepared by Dr.Mohammed Al-Shehab References: Essential skills in pediatrics & Nelson Textbook
History Taking Checklist – 2021 – 2PDFS
Personal History (^) ▪ Name, Age, Sex. ▪ Address & birth place. ▪ Number of kids in family ▪ Source of information. ▪ Date of admission Presenting Complaint (^) Brief ▪ In patient own words ▪ Duration ▪ Maximum 3 complaints History of present illness (at the end of HOPI, you have to know the affected system to narrow the differential diagnosis) Patient was well till …days before admission then started complaining of…… / or patient is a known case of ……disease comes complaining of….. Onset, course Timing (duration of symptom, frequency of attacks, diurnal variation) Predisposing factors Severity of symptom Aggravating and relieving factors Associated symptoms Specific additional information (analysis) according to complaints: o Pain: site, radiation, character, …. o Diarrhea & vomiting: amount, content, color, consistency, … Predicted complications Medication given & investigations done Child status now (General symptoms): FAWAS Systemic review Start from the related system to the affected system mentioned in HOPI. Peri-natal History: for children < 2 years or with developmental or neurological problems Prenatal History Antenatal care Infection: TORCH infections, tuberculosis, malaria, and hepatitis B. Illnesses: Anemia, diabetes, hypertension, preeclampsia, and heart diseases. Trauma Toxins and Teratogens: Drugs (phenytoin, warfarin, tetracycline, narcotics), radiation exposure and smoking Term or preterm pregnancy Tetanus vaccine Natal Vaginal (at home/hospital, spontaneous/induced) or cesarean section (indication) Fullterm or preterm Complicated or not (bleeding, obstructed or prolonged labor, PET, eclampsia) Fever (intrapartum) or premature rupture of membranes Postnatal Admission to nursery (indication, duration, status at discharge) Aspiration or meconium stained Convulsion Cried immediately or needed resuscitation Color (cyanosis, jaundice, ….) Past History Allergy Admission to hospital (indication) Blood transfusion Procedures & operations Diseases: epilepsy, DM, Asthma, celiac D, infectious Ds (pertussis, TB,…) Drug use: anti-epileptic Ds, insulin, inhaler, steroid,. Similar condition Specific questions (according to complaint) Family History ^ Consanguinity Chronic disorders (DM, epilepsy, asthma,,…) Similar condition in the family Siblings & parents' health Specific questions (according to complaint) Sudden death in the family Vaccination History Uptodate according schedule or not ▪ If missed (ask about the cause, site of injection for each vaccine) Dietetic History Infants: ▪ Breastfeeding (exclusive, on demand or scheduled, frequency, at night, both breasts). ▪ Weaning (age of weaning, type of food, frequency,..). ▪ Formula feeding (age of onset, type of milk, preparation, bottle or spoon, frequency, sterilization,….) Older child: No of meals & snacks per day, composition of child diet, adequacy of food(wt gain, …) For all children: ask about feeding problems (allergy, colic, vomiting, diarrhea,….) Developmental History Concerns about child's development, vision and hearing Delayed milestones (progressive/not, global or particular) Gross motor (head support, sitting, crawling, standing, walking,….) Fine motor (follows face, reach for toys, palmar grasp, transfer objects, scribble, copies circle) Speech & language (coos, babbles, says mama & dada, speache 1st^ word, sentences ) Social & behavioral (smile, puts food in mouth, fear of strangers, drink from cup, toilet trained) Social History (^) ▪ Parents eduction, occupation, habits as smoking. ▪ Housing: crowdedness, water supply & sanitation, ▪ Pets (gogs, cats,….) ▪ Travelling
CardivascularSystemExamination Checklist– 2023
6 - Checklist & Notes of Dr.Ahmed Hudnah, Dr.Ahlam Abdulmalik, Dr. Afrah Almurtadha, Dr.Samed 3 - Pediatric Exams; A Survival Guide, 2nd^ Edition 4 - MRCPCH Clinical Exam Made Simple 2011 5 - Pediatric OSCE Stations,Dr. Zuhair Almusawi References: 1 - Examination Pediatrics, 5th^ Edition 2018 2 Postgraduate clinical Examination, 3rd^ Edition Prepared by Dr.Mohammed Alshehab Case 3 Case 2 Case Task Mark 1
WIPE ( W ash your hand, I ntroduce yourself, P ermission & P osition, E xposure (from upper part of body to the waist),
Ask about name & age
General Inspection: ABCDE from the end of the bed
A. A ppearance( well/unwell ) , A lertness(conscious,..) B. P osture & B ody built(looks average or appropriate body built/ small for his age but I need to plot his weight & height on centile chart according to age) C. C olours( cyanosis , pallor & jaundice) & cutaneous manifestations (plethoric face, pigmentation,.) a. Dysmorphic features (down s, turner s,…) & signs of R. Distress ( in form of:flaring AN, recession, accessory muscle use.. & Resp. Rate at the end of examination) &dehydration
D. Equipment ( O2 mask or canula,IV canula,pulse oxymeter) & Edema.
Hands: Ask about pain-warm or cold hands
Posterior: clubbing - peripheral cyanosis-CRT(normal or delayed)- splinter hemorrhage-muscle wasting,.. Anterior: pallor - bony deformities - osler nodes- janeway lesion- muscle wasting
Radial Pulse: rate(in 10sec x 6)- rhythm - volume - symmetry - special character(collapsing pulse in PDA
& AI or slow rising pulse in AS) - radio-radial delay - radio-femoral delay(at the end) I will check blood pressure (in both upper limbs & in 4 limbs if suspect CoA), other vital signs & other peripheral pulses at the end of examination
Face: specific dysmorphism - pallor - jaundice - cyanosis – dental carries – tongue - ……………
Neck: short neck - trachea – thrill of AS – JVP (≥8yr) at the end of examination – visible(veins, swelling
or recession).
Inspection: SPS
Start from the end of bed & side of patient at the level of bed 1 - Shape &/or deformity – Symmetry (left chest prominence or right in dextrocardia) 2 - Precordial bulge – Pulsations ( apex /pulmonary/aortic/epigastric)
3 - Skin: Scars - dilated veins – pigmentations
Palpation: PTH (P:pain, position, pulse including apex – T: thrill – H: Heave).
1 - Ask about Pain, Position of mediastinum(trachea) then Warm your hands. 2 - Apex : by both hands on each side of chest wall for dextrocardia(if apex is elusive) – location – diffuse or localized - character (normal, hyperdynamic in volume overload as left to right shunt or sustained in pressure overload as in AS). 3 - Other pulsations: aortic – pulmonary (palpable S2) – epigastic - suprasternal 4 - Thrill (4 valves areas-suprasternal notch) 6 - Heave (left parasternal heave)
Auscultation(Z-shape): warm stethoscope → by bell at apex → by diaphragm ( for mitral area - ›
tricuspid area - › 4 th^ Lt intercostal space for VSD - › pulmonary area - › aortic area - › listen with breathing in and out, with changing position to left side & on sitting up position) 1 - S1(1st^ heart sound): normal, load(0n MS), quiet in MR) 2 - S2(2nd^ heart sound):load (Pulm. HTN,L - › R Shunt)&Split (normal split on inspiration, fixed split,..) 3 - Added sounds: S3, S4 gallop and Ejection click in AS & PS 4 - Murmurs: character - timing – duration – maximum intensity – grade – radiation if murmur audible(to neck in AS, to axilla in AR, TR & VSD and to back)–change with position & respiration
Back: vertebrae - Sacral edema – basal crepitation – radiation of murmurs(PS, CoA & PDA)
Abdomen: tender hepatomegaly(CCF)
Lower limbs: Femoral area(catheter scar)-femoral pulse(absent or delay in CoA)-edema-clubbing
Cover the patient & thanks
I have to finish my examination by: blood pressure measurement in all limbs, radio-femoral delay,
other vital signs, plot on growth chart, pulse oxymetry, fundoscopy & urine dipstick
Summary: I would like to my findings on the cardiovascular examination of Saleh
- › Always mention(either present or not ): cyanosis, respiratory distress at rest & dysmorphic features & clubbing - › Mention only if present: scars & pallor - › Then mention: pulse(rate,rhythm, character), apex beat(site,character), heave or thrill, 1st^ & 2nd^ heart sound(normal/abnormal), added sound & describe marmur. - › Then mention: presence or absence of signs of heart failure(liver & edema) Positive findings detection Diagnosis, differential diagnosis & investigations Total Mark
Abdominal Examination Checklist- 2023
7 - Checklist & Notes of Dr.Ahmed Hudnah, Dr.Ahlam Abdulmalik, Dr. Afrah Almurtadha, Dr.Samed 4 - Pediatric Exams; A Survival Guide, 2nd^ Edition 5 - Examination Pediatrics, 4th^ Edition 6 - Pediatric OSCE Stations,Dr. Zuhair Almusawi References: 1 - MRCPCH Clinical, 3rd^ Edition 2 - Postgraduate clinical Examination, 3rd^ Edition 3 - MRCPCH Clinical Exam Made Simple Prepared by Dr.Mohammed Alshehab
Task Case 1 Case 2^ Case 3
WIPER ( W ash your hand, I ntroduce yourself, P ermission, E xposure from nipple to knee, R eposition(for u..Rt side& pt) Ask about name & age then go to the end of bed General Inspection : ABCDE A. Appearance(well/unwell), Alertness (conscious,..) B. Posture & Body built (looks well-nourished or small for his age but I need to plot his weight & height on a centile chart according to age) C. Colours (cyanosis, pallor & jaundice), Cutaneous manifestations ( bruises, petechiae, café lat spots, rash as dermatitis herpatiformis or telangiectasia) D. Distress, Dysmorphic features & Dehydration.
E. Equipment ( canula, NGT, gastrostomy tube, Foley's catheter or nappies in older child )
Hands: stigmata of chronic liver diseases Anterior: pallor , palmar erythema, spider naevi & muscle wasting & deformity Posterior: koilonychias & leukonychia, clubbing , scratching marks then Pulse, flapping tremors & xanthoma Face: pallor - jaundice-central cyanosis - blue sclera-Kayser Fleischer rings Mouth (lip→gum→teeth→tongue→buccal cavity & palate): fetor hepaticus-cheilitis-gum hypertrophy-dental caries- tongue (colors, coating, glossitis or macroglossia)- ulcers or pigmentations Neck: Lymph nodes palpation from behind, other swelling or pulsations Chest: gynacomastia,spider naevi, scratching marks or dilated veins Inspection: CRUSH 1 - Contour of abdomen (generalized or localized distension or masses, flat or scaphoid) 2 - Respiratory movements 3 - Umbilicus (inverted or everted, midposition od shifted, discharge, caput medosa & hernia) 4 - Skin manifestations(3S2P1D) : Scar, Striae, Stoma, Visible Peristalsis, Pigmentations or Dilated Veins
5 - Hernia orifices & Genitalia (as ambiguous genitalia)
Palpation: distract the child, be gentle & flex the knee & hip to relax muscles & get down to the level of child 1 - Warm your hands & Warn the child you will palpate his tummy 2 - Ask about pain 3 - Superficial Palpation (9 regions): for tenderness, tone of abdominal wall muscles (guarding or rigidity) & masses (from LIF Z-shape) 4 - Deep Palpation (9 regions): for organomegaly or palpable mass 5 - Liver (from RIF with breathing) ECSSPT: Edge (regular or irregular), Consistency (soft, firm or hard), Surface (smooth or nodular), Span, Tenderness or Pulsation. 6 - Spleen (from RIF & in infants from LIF with breathing): Edge, Consistency, Surface, Notch, Unable to get above it & Movement on respiration & Size below costal margin at MCL & dull to percussion If uncertain is it palpable (use bimanual approach & turn the child to Rt side & palpate with inspiration) 7 - Kidney: bimanually palpable, ballotable, doesn't move with respiration & can get above it & resonant to percussion
8 - Masses: position, size, consistency, shape & motility
Percussion: for liver (upper & lower border to record span), spleen (lower border) & ascites (by shifting dullness & fluid thrill if abdomen distended or there are signs of CLD, hepatomegaly or edema elsewhere) Auscultation: 1 - Bowel sounds (increased or absent) 2 - Arterial bruit over the aorta & the renal angle ( RAS) 3 - Venous hum over RUQ if liver enlarged (continuous & softer then bruit): in portal HTN Back: scars, spines (for deformity & spina bifida/occulta) & lung bases Lower limbs: edema, clubbing Cover the patient & thanks I would like to complete the abdominal examination for the genitalia, the anal area(including skin tags, stool examination) as well as plotting the height & weight on a growth chart and checking other vital signs Summary
- › First mention a general observation: ex: Saleh looking ill, small for his age with NGT - › Always mention (present or not): jaundice, anemia & clubbing - › Mention only if present: other findings as scars,spider naive or umbilical hernia,… - › Then mention findings on exam. of abdomen itself (ex: the abdomen was generally soft & non tender apart from a smooth mass palpable 5 cm below the right costal margin which moved with respiration, could not be got above it & was dull to percussion with no abnormal associated sounds. These findings are consistent with hepatomegaly ) Positive findings detection Discussion (D.D & Management)
