PEDIATRIC HISTORY and PHYSICAL EXAMINATION

1. PEDIATRIC HISTORY and PHYSICAL EXAMINATION Prof.Dr. AYÇA VİTRİNEL

2. A) SOURCE OF HISTORY • B) INTERPRETATION OF HISTORY • C) DIRECTION OF QUESTIONING • D) RECORDED HISTORY

3. HISTORY OUTLINE • Name: Place of birth: • Adress: Referred by whom: • Tel. no: Father and mother’s name: • Sex: Previous entries:

4. PRESENTING COMPLAINT • Patient’s or informant’s own brief account of the complaint and its duration.

5. HISTORY 1 Present illness Previous health – Antenatal health of mother -Natal duration of pregnancy,birth weight Kind of duration of labor, type of delivery, state of infant at birth, resuscitation required , onset of respiration, first cry?

6. HISTORY 2 -Neonatal APGAR, color, cyanosis, pallor, jaundice, cry, excessive mucus, convulsions, fever, congenital anomalies, birth injury, difficulty in sucking, length of hospital stay.

7. HISTORY 3 • Development, -First raised head, rolled over, sat alone, pulled up,walked with help/alone, talked, urinary continance during night and day, control of defecation, comparison of development with that of siblings any period of failure to grow, school grade?

8. HISTORY 4 • Nutrition –Breast or formula feeding, supplements, solid foods, appetite, time of weaning • Illinesses –Infections,contagious diseases • Immunizations –DTP,BCG,MMR,HB etc... • Operations • Accidents and injuries • Medications –choronic use of medication,allergy of medication?

9. HISTORY 5 • Family history – Father/mother/siblings age and condition of health, significant previous illness and problems. • Tbc,allergy,mental and nervous system diseases, D.M., C.V.S diseases, kidney disease , neoplastic diseases, rheumotalogic diseases, congenital abnormalities, convulsive disorders. • Personality history –Relation with other children, school progress.

10. HISTORY 6 • Social history – Family of income, home, who takes care of patient who else lives in the house besides immediate family. • Habits of eating, sleeping, elimination, disturbances, adolescent habits, dental hygiene

11. SYSTEM REVIEW 1 • Ears,nose,throat: Frequent colds, sore throat, sneezing, discharge, postnasal drip, mouth breathing, otitis, hearing, adenitis, allergies • Teeth: Number at1 age year, age at eruption.

12. SYSTEM REVIEW 2 • Cardiorespiratory system: Dispnea, chest pain, cough, sputum, wheeze, cyanosis, edema, syncope, tachycardia. • Gastrointestinal system: Vomiting, diarrhea, constipation, type of stools, abdominal pain, jaundice • Genitourinary system: Enuresis, dysuria, frequency, polyuria, pyuria, hematuria, vaginal discharge, mensturial history, bladder control, abnormalities of penis or testes.

13. SYSTEM REVIEW 3 • Neuromusculer system: Headache, nervousness, dizziness, convulsions, ataxia, musculer or joint pains, postural deformites, exercise tolerance. • Endocrine system: Disturbances of growth, excessive fluid intake, polyphagia, goiter, thyroid diseases. • General review: Unusual weigh gain/loss, fatigue, skin color, abnormalities of skin, temperature sensitivity, bleeding tendency.

14. PHYSICAL EXAMINATION • OBSERVING THE CHILD • HOLDING THE CHILD FOR EXAM • Before age 6 months: Examining table is well tolerated • 6 months-3/4 years: Examination may be performed while the child is held in parent’s lap over the parent’s shoulder • REMOVAL OF CLOTHING • PAINFUL PROCEDURES

15. GENERAL PHYSICAL EXAMINATION 1 • RECORD: Temperature, pulse rate, respiratory rate, blood pressure, weight and height, head circumference. • GENERAL APPEREANCE: Degree of cooperation, state of comfort, nutrition, consciousness, abnormalities; gait, posture, coordination, estimate of intelligence, reaction to parents, nature of cry.

16. GENERAL PHYSICAL EXAMINATION 2 • SKIN: Color, eruptions, hydration, edema, scars, dilated vessels, hemangiomas, turgor/tonus, mongolian spots, desqumation • LYMPH NODES: Locality, size, sensitivity, mobility, consitency • HEAD: Size, shape,circumference, asymmetry, cephalhematoma, craniotabes, bruits, fontanelles, sutures

17. GENERAL PHYSICAL EXAMINATION 3 • FACE: Symmetry, paralysis, distance between, nose and mouth, depth of nasolabial folds, bridge of nose, distrubition of hair, size of mandible, hypertelorizm, tenderness over sinuses • EYES:Photophobia, nistagmus, lacrimation, discharge, lids, exopthalmus, enophtalmus, conjuctiva, pupillary size, reaction to light

18. GENERAL PHYSICAL EXAMINATION 4 • NOSE: Shape, mucosa, discharge,bleeding, flaring of nostils. • MOUTH: Lips, teeth, mucosa, gums, palate, tongue, uvula, mouth breathing, geographic tongue. • EARS: Pinnas, canals, tympanic mem branes, mastoid ten derness, hearing

19. GENERAL PHYSICAL EXAMINATION 5 • NECK: Position, swelling, thyroid, lymph nodes, position of trachea, SCM, moving. • THORAX: Shape and symmetry, retractions, Harrison’s groove, pigeon breast, funnel shape, size and nipples, length of sternum. • LUNGS: Type of breathing, dyspnea, prolongation of expiration, cough, flatness or dulness of percussion, rales, wheezing

20. GENERAL PHYSICAL EXAMINATION 6 • HEART:Location of and intensity of apex beat, pulsation of vessels, thrills, size, shape, auscultation; rate, rhytm, quality of sounds. Murmurs; location, position in cycle, intensity, effect of exercise. • ABDOMEN: Size, visible peristalsis, respiratory movements, umbliculus, hernia, tenderness and rigidity, rebound, tympany, pulsation, palpable organs, bowel sounds

21. GENERAL PHYSICAL EXAMINATION 7 • MALE GENITALIA:Circumcision, meatal opening, hypospadias,phimosis, size of testes, cryptorchidism, scrotum, hydrocele, hernia, pubertal changes • FEMALE GENITALIA:Vagina, hypertrophy of clitoris, pubertal changes • RECTUM&ANUS: Irritation, fissures, prolapse, imperforate anus

23. GENERAL PHYSICAL EXAMINATION 8 • EXTREMITIES: GENERAL: Deformity, hemihypertrophy, hemiatrophy, knock knee, paralysis, edema, posture, gait, asymmetry • JOINTS: Swelling, redness, pain, limitation, tenderness, motion,rheumatic nodules, tibial torsion • HANDS&FEET:Extradigits, deformity of nails, splinter hemorrhages, flatfeet, syndactily

25. GENERAL PHYSICAL EXAMINATION 9 • SPINE AND BACK: Posture, curvatures, rigidity, spina bifida, pilonoidal dimple, mongolian spots, tenderness over the spine, pelvis, kidneys.