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"Children are not little adults. Theyare unique."
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History Taking
in Paediatric
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Fundamentals of
Diagnosis
Skillful history-taking
Powers of observation Careful physical exam
Wise selection of Investigations
Good clinical judgment
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More errors are made because of inadequate
history-taking and superficial exam than anyother cause.
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History Taking
Onset
Progression
Duration Severity
Aggravating factor
Relieving factor
Associated factor
Site, Character & Radiation
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After her visits to OPD SARA goes to
South Circular Road (SCR)
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Component of History
Taking
Chief Complaint
HxPI
PMHx & PSHx
Antenatal & post natal history Feeding/dietary
Growth & Development
Immunizations
Medications & Allergies
Family & Social
Summary
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Chief complaint..
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Chief complaint
Sara 1 year 2 month old.. vs Sara 14month old..
Known case of.. vs underlying history of.. Was admitted to hospital on 5thJuly vs
was admitted to hospital 3 days ago
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Chief complaint
Keep it simple
No medical jargon
Implies your working diagnosis..
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Bad chief complaint
Sara a 1 year 7 month old girl fromPuchong, was admitted on 5thof July
complaining of fever, rashes, runny nose& vomiting.
Sara a 1 year 7 month old girl fromPuchong, was admitted on 5thof Julywith 3 days history of fever, vomiting &runny nose and rashes on day 2 of fever.
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Good chief complaint
Sara a 1 !-year-old girl from Puchong,was admitted to hospital following a 3
days history of fever & rashes. Sara a 1 !-year-old girl from Puchong,
was admitted to hospital with 3 dayshistory of facial puffiness and legswelling.
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History of presenting
illness
Simplified
What you have found rather than what
parents say. CHRONOLOGICAL ORDER!
Summarizing, not reporting or story telling
Follow conventional format(OPD SARASCR)
Ask relevant associated symptoms
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Bad reporter
Sara a 1 !-year-old girl from Puchong,was admitted to hospital following a 3days history of fever & rashes.
After day 1 of fever mother brought her tosee a GP where she received PCM &antibiotics.
As fever not settling, mum brought her toanother GP who said she should come
back on day 4 if fever persist.
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Bad reporting
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Good reporter..
Sara a 1 !-year-old girl from Puchong,was admitted to hospital following a 3
days history fever & rashes. She was brought to Serdang hospital after
3 days of persistent fever followingseveral visits to GP & a private hospital.
Her feverOPD SARA
Her rashesOPD SARA
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PMHx/PSHx
Important especially in recurrent/chronic
diseases
Might be related to HxPI
Chronological order!
If many events, summarize
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Antenatal & post natal
Hx
Health and age of mother in pregnancy
Antenatal scans and tests
Birth - Gestation, Mode, BWt, AS(conditionbaby at birth)
Any immediate health problems after birth(Admission to NICU, prolonged stay in
hospital after birth)
Any health problems in first few weeks oflife
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Feeding/Dietary
Breast/bottle fed
How long breast feeding
Bottle feed - what type, how much/24 hr
Weaning what age What type of solid food taken?
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Growth
Assess child physical growth
Parent held record
details/plots of previous weight &lengths/heights
For older children - onset of puberty
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Development
Commonly used developmental milestones
Make a card to carry around
Younger children : ask all 4 domains
Older children :
ask school performance Parent forget :
compare with other siblings
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Immunization
Missed dose - ask why?
Up to date
Completed up to age vs
Last vaccination was at 12 month of age.
No problem occurred after eachvaccination.
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Medications & allergies
Type, dosage, frequency Specific drug allergies or sensitivities
Food allergies
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family hx
Are you and your partner related? -CONSANGUINITY
Family tree - 3 generations ( ages, health,
cause of death)
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Social hx
Who makes up the household?
Size and type of accommodation
Parents occupation
Financial problems
Smoking/Drinking problems in family
Caretaker?
Childs school, school work, friends Problems at school (bullying, teasing)
DIFFICULT & SENSITIVE - practice some clear Q to avoidembarrasement
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can medical studentsgive advice to parents
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SUMMARY
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Bad Summary
In summary, Sara a 1 !-year-old girlfrom Puchong, was admitted to hospital
on 5th
July 2010 with a 3 days history offever & 2 days history of rashes whichappeared on day 2 of fever which isassociated with vomiting, diarrhoea,
cough and poor oral intake. However shedoes not have any abdominal distensionand has no urinary symptoms.
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Summary is not telling story..
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Summary
In summary, Sara a 1 !-year-old girlfrom a dengue endemic area in Puchong,
was admitted to hospital following a 3days history of persistent fever &generalized rashes.
In summary, Sara a 1 !-year-old girlfrom Puchong, was admitted to hospitalfollowing a 3 days history of persistentfever & generalized rashes.
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presenting a history is
an art
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Commentary.
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