Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Welcome to: Course 473 Peds Dr Mohamad-Hani Ali Temsah Asst. Professor of Pediatrics Pediatric Intensivist KKUH – King Saud University Riyadh – Saudi Arabia Goals • By completing this course, each student is expected to Have general knowledge about pediatrics Master the basic principles and skills of pediatrics that will allow him to work as an efficient and safe intern Keys to Success in this course • • • • • • Punctuality Motivation Lots of clinical exposure Critical thinking Make good use of your teachers Reading …. Practicing ….. Feedback! Recommended Readings http://www.geocities.com/kkuh_pedia Student s Guide Student’ Distribution 4 Major groups A,B,C, and D; each subdivided into 3 subgroups (e.g. A1, A2, A3) total of 12 subgroups: subgroups in KKUH subgroups in KFMC / RMC Swab in week 7 Activities Tutorials: always come prepared Clinical sessions: 9-12 am, 2/wk Ward rotation: as a sub intern OPD: AM or PM ER: 8-12, 12-4, 4-8 Nursery: AM or PM Morning report: important to attend & participate Activities • • • • • • Clerking: Should be genuine Hand written, readable and clear Stick to the given format Strictly adhere to time limits Different cases, from different systems Exams • MCQs: Mid-Cycle: usually in week 9 Final: week 12 Case scenario format • OSCE: week 12 5 stations including history taking, physical examination and oral Extra Notes • Extra sessions arranged for the whole group should only be on Thursdays • Remember to fill the course evaluation sheet and submit it during the mid-cycle exam • Remember: We are here for you • WE WISH YOU THE BEST OF LUCK History Taking in Pediatrics Similar to adults, Plus! History • Patient ID • Family History (FHX) • Present Complaint(s) ( C/O) • Social History • History of Present Complaint(s) (HPI) • Vaccination History • Past Medical History (PMHX) • Pregnancy and delivery • Neonatal History • Systemic Review • Nutritional History • Developmental History • Drugs • Allergy Identifying Data: • Patient's name, age, sex; Informant (parent): Reliability! Chief Compliant (CC): • Reason that the child is seeking medical care and duration of the symptom. History of Present Illness (HPI): • Describe the course of the patient's illness, when and how it began, character of the symptoms; aggravating or alleviating factors; pertinent positives and negatives, past diagnostic testing. Past Medical History (PMH): • Medical problems, • hospitalizations, • operations; Perinatal History: • • • • • • Gestational age at birth, obstetrical complications, type of delivery, birth weight, Apgar scores, complications (eg, infection, jaundice), length of hospital stay. Nutrition: Breast feeding vs. bottle Amount and frequency Quality of food Medications: • Names and dosages • Allergies to Rx or Food Developmental History 1. Gross Motor: e.g. sitting and walking 2. Fine Motor:e.g. Pincer grasp and scribble 3. Language:e.g. say “mama”“baba”and two words sentence 4. Social: e.g. smiling, playing with others • Relationships with siblings, peers, adults. • School grade and performance, behavioral problems. Immunizations: • • • • • Know the local schedule Type of vaccine: killed or live-attenuated How they are given? Adverse reactions Avoid “up to date” Family History • More detailed • Learn to draw family pedigree Family History: • Medical problems in family, including the patient's disorder; diabetes, seizures, asthma, allergies, cancer, cardiac, renal or GI disease, tuberculosis, smoking. Social History: • • • • • • School level and grades Relationship with parents and siblings Friends Family situation, smoking, drugs. Parental level of education. Safety: Child car seats, smoke detectors, bicycle helmets. Review of Systems (ROS) • General: Overall health, weight loss, behavioral changes, fever, fatigue. • Skin: Rashes, moles, bruising, lumps/bumps, nail/hair changes. • Eyes: Visual problems, eye pain. • Ear, nose, throat: Frequency of colds, pharyngitis, otitis media. Cont. ROS • Lungs: Cough, shortness of breath, wheezing. • Cardiovascular: Chest pain, murmurs, syncope. • Gastrointestinal: Nausea/vomiting, spitting up, diarrhea, recurrent abdominal pain, constipation, blood in stools. Cont. ROS • Genitourinary: Dysuria, hematuria, polyuria, discharge. • Musculoskeletal: Weakness, joint pain, gait abnormalities, scoliosis. • Neurological: Headache, seizures. • Endocrine: Growth delay, polyphagia, excessive thirst/fluid intake, menses duration, amount of flow. TIPS • Some parents may exaggerate or mislead you so ask specific questions • Avoid leading questions! • Show appreciation and empathy with parents anxiety and worry • Be aware of the sensitivity of some issues in the family life • Take note of the parents behavior Questions? • Contact e-mail: [email protected] Pediatric Physical Examination Video Demos (45 minutes) Observation: • Child's facial expression (pain), response to social overtures. • Interaction with caretakers and examiner. • Body position (leaning forward in sitting position; epiglottitis, pericarditis). • Weak cry (serious illness), high-pitched cry (increased intracranial pressure, metabolic disorder); moaning (serious illness, meningitis), grunting (respiratory distress). Does the child appear to be: (1) Well, acutely ill/toxic, chronically ill, wasted, or malnourished? (2) Alert and active or lethargic/fatigued? (3) Well hydrated or dehydrated? (4) Unusual body odors? Vital Signs: • Respiratory rate, blood pressure, pulse, temperature. • Measurements: Height, weight; head circumference in children up-to 2 years; plot on growth charts and determine growth percentiles. • Skin: Cyanosis, jaundice, pallor, rashes, skin turgor, edema, hemangiomas, café au lait spots, nevi, Mongolian spots, hair distribution, capillary refill (in seconds). • Lymph Nodes: Location, size, tenderness, mobility and consistency of cervical, axillary, supraclavicular, and inguinal nodes. • Head: Size, shape, asymmetry, cephalohematoma, bossing, molding, bruits, fontanelles (size, tension), dilated veins, facial asymmetry. • Eyes: Pupils equal round and reactive to light and accommodation ( PERRLA); extraocular movements intact ( EOMI); Brushfield's spots; epicanthic folds, discharge, conjunctiva; red reflex, corneal opacities, cataracts, fundi; strabismus (eye deviation), visual acuity. • Ears: Pinnas (position, size), tympanic membranes (landmarks, mobility, erythema, dull, shiny, bulging), hearing. • Nose: Shape, discharge, bleeding, mucosa, patency. • Mouth: Lips (thinness, downturning, fissures, cleft lip), teeth, mucus membrane color and moisture (enanthem, Epstein's pearls), tongue, cleft palate. • Throat: Tonsils (erythema, exudate), postnasal drip, hoarseness, stridor. • Neck: Torticollis, lymphadenopathy, thyroid nodules, position of trachea. • Thorax: Shape, symmetry, intercostal or substemal retractions. • Breasts: Turner stage, size, shape, symmetry, masses, nipple discharge, gynecomastia. • Lungs: Breathing rate, depth, expansion, prolongation of expiration, fremitus, dullness to percussion, breath sounds, crackles, wheezing, rhonchi. • Heart: Location of apical impulse. Regular rate and rhythm ( RRR), first and second heart sounds (S1, S2); gallops (S3, S4), murmurs (location, position in cycle, intensity grade 1-6, pitch, effect of change of position, transmission). Comparison of brachial and femoral pulses. • Abdomen: Contour, visible peristalsis, respiratory movements, dilated veins, umbilicus, bowel sounds, bruits, hernia. Rebound tenderness, tympany; hepatomegaly, splenomegaly, masses. • Genitalia: Circumcision, hypospadias, phimosis, size of testes, cryptorchidism, hydrocele, hernia, inguinal masses, discharge, labial adhesions, clitoral hypertrophy, pubertal changes. • Rectum and Anus: Erythema, excoriation, fissures, prolapse, imperforate anus. Anal tone, masses, tenderness, anal reflex. • Extremities: Bow legs (infancy), knock knees (age 2 to 3 years). Edema (grade 1-4+), cyanosis, clubbing. Joint range of motion, swelling, redness, tenderness. A "click" felt on rotation of hips indicates developmental hip dislocation (Barlow maneuver). Extra digits, simian lines, pitting of nails, flat feet. • Spine and Back: Scoliosis, rigidity, pilonidal dimple, pilonidal cyst, sacral hair tufts; tenderness over spine or costovertebral tenderness. • • • • • Neurological Examination: Behavior: Level of consciousness, intelligence, emotional status. Motor system: Gait, muscle tone, strength (graded 0 to 5). Reflexes Deep Tendon Reflexes: Biceps, brachioradialis, triceps, patellar, and Achilles reflexes (graded 1-4). • Superficial Reflexes: Abdominal, cremasteric, plantar reflexes • Neonatal Reflexes: Babinski, Landau, Moro, rooting, suck, grasp, tonic neck reflexes. • Developmental Assessment: Delayed abilities for age on developmental screening test. • Laboratory Evaluation: Electrolytes (sodium, potassium, bicarbonate, chloride, BUN, creatinine), CBC (hemoglobin, hematocrit, WBC count, platelets, differential); X-rays, urinalysis ( UA). • Assessment: Assign a number to each problem, and discuss each problem separately. Discuss the differential diagnosis, and give reasons that support the working diagnosis. Give reasons for excluding other diagnoses. • Plan: Describe therapeutic plan for each numbered problem, including testing, laboratory studies, medications, antibiotics, and consultations. Work Hard, Become Excellent! Best Wishes!