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Study Guide for Physical Exam.
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(CHILDREN ARE NOT JUST LITTLE ADULTS)
Learning Objectives :
Competencies:
Differences of a Pediatric History Compared to an Adult History : I. Content Differences A. Prenatal and birth history B. Developmental history C. Social history of family - environmental risks D. Immunization history
II. Parent as Historian A. Parent’s interpretation of signs, symptoms
Outline of the Pediatric History: I. Chief Complaint A. Brief statement of primary problem (including duration) that caused family to seek medical attention
II. History of Present Illness A. Initial statement identifying the historian, that person’s relationship to patient and their reliability B. Age, sex, race, and other important identifying information about patient C. Concise chronological account of the illness, including any previous treatment with full description of symptoms (pertinent positives) and pertinent negatives. It belongs here if it is relates to the differential diagnosis for the chief complaint.
III. Past Medical History A. Major medical illnesses B. Major surgical illnesses-list operations and dates C. Trauma-fractures, lacerations D. Previous hospital admissions with dates and diagnoses E. Current medications F. Known allergies (not just drugs) G. Immunization status - be specific, not just up to date
IV. Pregnancy and Birth History A. Maternal health during pregnancy: bleeding, trauma, hypertension, fevers, infectious illnesses, medications, drugs, alcohol, smoking, rupture of membranes B. Gestational age at delivery C. Labor and delivery - length of labor, fetal distress, type of delivery (vaginal, cesarean section), use of forceps, anesthesia, breech delivery D. Neonatal period - Apgar scores, breathing problems, use of oxygen, need for intensive care, hyperbilirubinemia, birth injuries, feeding problems, length of stay, birth weight
V. Developmental History A. Ages at which milestones were achieved and current developmental abilities - smiling, rolling, sitting alone, crawling, walking, running, 1st word, toilet training, riding tricycle, etc (see developmental charts) B. School-present grade, specific problems, interaction with peers C. Behavior - enuresis, temper tantrums, thumb sucking, pica, nightmares etc.
VI. Feeding History A. Breast or bottle fed, types of formula, frequency and amount, reasons for any changes in formula B. Solids - when introduced, problems created by specific types C. Fluoride use
Differences in Performing A Pediatric Physical Examination Compared to an Adult: I. General Approach A. Gather as much data as possible by observation first B. Position of child: parent’s lap vs. exam table C. Stay at the child’s level as much as possible. Do not tower!! C. Order of exam: least distressing to most distressing D. Rapport with child
II. Vital signs A. Normals differ from adults, and vary according to age
Outline of a Pediatric Physical Examination I. Vitals - see above
II. General A. Statement about striking and/or important features. Nutritional status, level of consciousness, toxic or distressed, cyanosis, cooperation, hydration, dysmorphology, mental state B. Obtain accurate weight, height and OFC
III. Skin and Lymphatics
A. Birthmarks - nevi, hemangiomas, mongolian spots etc B. Rashes, petechiae, desquamation, pigmentation, jaundice, texture, turgor C. Lymph node enlargement, location, mobility, consistency D. Scars or injuries, especially in patterns suggestive of abuse
IV. Head A. Size and shape B. Fontanelle(s)
V. Eyes A. General
VI. Ears A. Position of ears
V. Nose A. Nasal septum B. Mucosa (color, polyps) C. Sinus tenderness D. Discharge
VI. Mouth and Throat A. Lips (colors, fissures) B. Buccal mucosa (color, vesicles, moist or dry) C. Tongue (color, papillae, position, tremors) D. Teeth and gums (number, condition) E. Palate (intact, arch) F. Tonsils (size, color, exudates) G. Posterior pharyngeal wall (color, lymph hyperplasia, bulging) H. Gag reflex
V. Neck
X. Neurologic - most accomplished through observation alone A. Cranial nerves B. Sensation C. Cerebellum D. Muscle tone and strength E. Reflexes
XI. GU A. External genitalia B. Hernias and Hydrocoeles