HISTORY TAKING

• IDENTIFICATION
-Name, Age, Sex, Address, Parental age, Parental
Ethnicity/religion, occupation
-Source of history - Mother/Father/care taker

• PREVIOUS ADMISSION
-Time
-Reason
-Duration
-Treatment
-Outcome

08/02/2020 1
 .

CHIEF COMPLAINT/S:

-Cough
-Diarrhea
-Vomitting
-Fever
-Skin rashes/lesions
-Earache/discharge
-Loss of conciousness

08/02/2020 . 2
 .

• HISTORY OF PRESENT ILLNESS

 Elaboration of the chief complaint with regard to:
-The duration
-Characteristics
-Frequency
-Aggravating / relieving factor ( if any )
-Predisposing factor
-Complications
ASSOCIATED SYMPTOMS
-Other possible causes (DDx)
-Inclusion of other important historical parts
-Any treatment the patient received for the complaint (type, duration,
outcome)

08/02/2020 3
 .

• PERSONAL,
-School attendance & performance
FAMILY & SOCIAL HISTORY
-Family size
-Number of siblings (age, sex, health status)
-Housing condition
-Type of house
-Number of rooms
-Number of doors/windows
-Isolated kitchen or no
-Isolated room for cattle or no
-Water source
-Waste disposal system
-Family income
-Any familial disease -DM, HTN, Asthma, Genetic disease

08/02/2020 4
 PHYSICAL EXAMINATION
• GENERAL APPEARANCE
-Sick looking or not?(Acute/Chronic)
-Level of conciousnessin(Change in mentation)
-Behaviour
-Orientation of the patient
-Cardiorespiratory distress
-Nutritional state
-Any dysmorphic feature
-Any obvious swelling or pallor

08/02/2020 . 5
 VITAL SIGNS
• Blood pressure
• Pulse rate (heart rate should be timed for 30 s)
• Respiratory rate
• Temperature
• Height
• Weight
• BMI
• Waist circumference

08/02/2020 . 6
 .

 VITAL SIGNS

-PR / HR b/n 60-100bpm

-RR -b/n 14-20 normal

- Fast breathing: >20bpm

-BP:
- Between= - SBP 90-120
- DBP 60-85

-Temperature:
- normal - 36.5-37.4 degree Celsius
-LGF - 37.5-38.4 degree Celsius
-HGF - >/= 38.5 degree celsius
-Hypothermia - <36.5 degree celcius

08/02/2020 . 7
 BLOOD PRESSURE MEASURING APPARATUS
• Mercury sphygmomanometers

08/02/2020 8
• The cuff should be placed 1 to 2 cm above the
antecubital fossa to allow for placement of the
stethoscope over the brachial artery
• Neither the patient nor the observer should talk
during the measurement

08/02/2020 . 9
• Take at least two readings on each visit, separated
by as much time as possible; if readings vary by
more than 5 mmHg, take additional reading until
two consecutive readings are close

08/02/2020 . 10
 GUIDELINES FOR THE MEASUREMENT OF BLOOD PRESSURE

• Allow the patient to sit quietly for 5-10 minutes

before measuring blood pressure
• No caffeine during the hour preceding the reading
and no smoking during the preceding 30 minutes

08/02/2020 . 11
• The patient should be seated comfortably with the
back supported and the upper arm bared without
constrictive clothing
• The legs should not be crossed

08/02/2020 12
 GUIDELINES FOR THE MEASUREMENT OF BLOOD PRESSURE

• The arm should be supported at heart level, and the

bladder of the cuff should encircle at least 80% of the arm
circumference

• Inappropriately small and large cuff will result in

overestimation and underestimation of the true blood
pressure respectively

08/02/2020 . 13
 Cont…
HEENT

-Pink/pale conjuctivae

-Color of isclerae

-Sunken eyes

-Periorbital swelling

08/02/2020 . 14
 Cont…
-Any scalp lesion
-Nasal discharge, congestion,swelling, bleeding
-Dental carries
-Dental alignment
-Any lost tooth
-Ear discharge/ ulceration/bleeding
-Tonsils / uvula
-Oral thrash / ulceration

08/02/2020 . 15
 .

LGS
-Any palpable LN -Size
-Concistency
-Ulceration
-attachment
-Breast - Shape
-Contour
-Discharge
-Ulcer
-Swelling/lump
-Testicles -Size
-Position
-Any swelling
-tenderness

08/02/2020 . 16
 .

• RESPIRATORY
 Inspection:
-RR
-Grunting
-Stridor
-Wheezing
-IC/SC{intercostal IC} {supcostal SC} retration
-Flarring of ala nasae
-Cyanosis
-Type of cough (barking, paroxysmal)

08/02/2020 . 17
 Cont…
 Palpation(4Ts)
-Tracheal position
-Tenderness to chest wall /mass
-Total Chest expansion
-Tactile fremitus

08/02/2020 18
 Cont…

 Percussion
-Diaphragmatic excursion =
-Resonant/dull/hyperresonant?

 Auscultation
-Air entry
-Adventitious sounds (BBS, wheezing, bronchophony, egophony, etc.)
-Transmitted sounds

08/02/2020 . 19
 EXAMINATION OF THE ARTERIAL
SYSTEM
EXAMINATION OF THE CARDIOVASCULAR SYSTEM

08/02/2020 . 20
 .

• CARDIOVASCULAR SYSTEM
 General examination
-Cyanosis
-Digital clubbing
-Cardiorespiratory distress

 Arterial examination
-Pulse ( rate, character, volume, radiofemoral delay)
-BP

08/02/2020 21
 EXAMINATION OF THE ARTERIAL SYSTEM

1. Assessing the pulses

 Rate
 Rhythm
 Character
 Volume/Amplitude
2. Assessing the vessel wall
3. Auscultation
 Bruit

08/02/2020 22
 RHYTHM

• Regular

• Regularly Irregular

• Irregularly Irregular

08/02/2020 . 23
 Venous system examination

-Jagular Veneous Pressure

-Hepatojagular reflux
The sternal angle is used as the reference.

• A distance of >3 cm is considered abnormal

08/02/2020 . 24
 MEASURING CVP

08/02/2020 25
 PATHOLOGIC CAUSES OF RAISED JVP

• Heart failure
• Pericardial effusion
• Constrictive pericarditis
• Superior vena cava obstruction

08/02/2020 26
 Precordial examination
 -Inspection:
- Precordial bulge
-Active / silent precordium
-Apical impulse
-Palpation:
-PMI
-Heave
-Thrill
-Auscultation:
-Normal heart sounds
-Murmur (type, quality, grade, radiation)
-Accentuation / muffling of heart sounds
-Gallope rhythm

08/02/2020 27
 WHAT TO AUSCULTATE?

1. Heart sounds
2. Murmurs
3. Pericardial friction rub

08/02/2020 . 28
 .

• ABDOMEN
 Inspection
-Full / scaphoid /distended
-Any isolated swelling
-Moves with respiration or no
-Visible peristalisis
-Any scar
-Distended veins
-Hernial sites
-Umblicus ( everted, inverted)
 Auscultation
-Bowel sounds
-Bruit
-Splenic rub

08/02/2020 29
 Cont…

 Palpation
-Superficial palpation: for tenderness or mass
-If any distended vein, direction of drainage
-Deep palpation: for organomegally, any mass, tenderness
 Percussion
-Shifting dullness
-Fluid thrill
-Total liver span

08/02/2020 . 30
 .

• GENITOURINARY SYSTEM
-Bladder distension
-CVAT
-Suprapubic tenderness
-Urethral opening (epispadias, hypospadias)
-Testicles in the scrotum or no
-Scrotal swelling
-Urethral discharge
-Vaginal discharge / bleeding
-Vulvar erythema / ulceration

08/02/2020 . 31
 .

 INTEGUMENTARY SYSTEM
-Palmar pallor ( some / sever )
-Rash ( characteristic , distribution, color)
-Any skin lesion ( characterstic, distribution)
-Edema ( grade, pitting / nonpitting)

08/02/2020 Hx & P/E IN PEDIATRICS By Wedaj D. 32

MUSCULOSKELETAL SYSTEM
-Any deformity ( kyphosis, scoliosis,)
-Joint swelling
-Limitation of movement at joint areas
-Tenderness at joint areas
-Gibbus deformity
-Any wound ( site, size, type of discharge)
-Any swelling
-Any abnormal movement
-Bony tenderness
-Muscle bulk ( any visible wasting )
08/02/2020 Hx & P/E IN PEDIATRICS By Wedaj D. 33
 Edema

08/02/2020 Hx & P/E IN PEDIATRICS By Wedaj D. 34

 .

• NERVOUS SYSTEM
 General
-Behaviour
-Abnormal facies
-Level of conciousness
-Seizure
-Abnormal odor- Fruity odor
-Pattern of breathing
-Kussmauls breathing

08/02/2020 Hx & P/E IN PEDIATRICS By Wedaj D. 35

 Cont…

 Cranial nerves
 Sensory examination
-Pain
-Position
-Vibration
-Temperature
-Sensory level
-Superficial abdominal reflexes

08/02/2020 Hx & P/E IN PEDIATRICS By Wedaj D. 36

 Cont…

 Motor
-Power
-Tone
-Deep Tendon Reflex
-Muscle Bulk
-Motility & locomotion

08/02/2020 Hx & P/E IN PEDIATRICS By Wedaj D. 37