Systems examination


KEY QUESTIONS FROM THE HISTORY


Breathlessness



  • Consider the severity of breathing problems with activities
  • Poor weight gain in infancy (a sign of respiratory distress)

Cough



  • Chronology—any link to time of day/activity/environment
  • Nature of cough: dry (viral), loose (productive), barking (croup), paradoxical (forced repetitive cough with difficult inspiration, seen in whooping cough)

Feeding in Infancy



  • Choking (gastro-oesophageal reflux)
  • Symptoms with introduction of formula milk (cow’s milk protein allergy)

Fever


Noisy Breathing



  • Noise in expiration (wheeze = lower airway obstruction)
  • Noise in inspiration (stridor = upper airway obstruction)

Cough, Wheeze or Stridor in a Young Child



  • If sudden onset, is there a history of inhaled foreign body or choking?

Ear, Nose and Throat



  • Child pulling at their ears (middle ear infection)
  • Difficulty in swallowing (tonsillitis or epiglottitis)
  • Offensive odour breath (bacterial infection)
  • Nasal secretions, bleeding

Family History



  • Family history of respiratory problems (asthma, cystic fibrosis)
  • Asthma, eczema, hay fever in close relative (atopy)
  • Any smokers or pet animals in household?
  • Travel to area of high tuberculosis prevalence, or contact with infected relative?
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KEY QUESTIONS FROM THE HISTORY


Medical Condition Associated with Cardiovascular Problems



  • Genetic syndromes involving structural heart defects (e.g. Down’s, Turner’s, Marfan’s syndromes)
  • Renal problems (hypertension)
  • Chemotherapy (some drugs cardiotoxic)

Breathlessness



  • Breathing difficulties without signs of acute infection (consider cardiac disease)

Exercise



  • Exercise limited by shortness of breath, palpitations or chest pain
  • Competitive sports—rarely these may need to be limited with some cardiac defects

Colour Change



  • Cyanosis—central (tongue) or peripheral (hands and feet)
  • Pale and sweaty, poor perfusion (sign of cardiac failure or an arrhythmia)

Growth



  • Feeding problems in babies (breathlessness impairs feeding)
  • Poor weight gain on growth chart

Syncope



  • Unexplained collapse or fainting
  • Collapse linked with exercise
  • Palpitations
  • Ask the parents to demonstrate rate/rhythm by tapping with their hand

Murmurs



  • Previously noted heart murmur (physiological flow murmurs sometimes audible only at times of illness or after exercise)

Family History



  • Family history of congenital heart disease
  • Sudden death in early adulthood (congenital cardiomyopathy)
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Jul 2, 2016 | Posted by in PEDIATRICS | Comments Off on Systems examination
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