Paediatric-History taking and physical examination of a patient with fever and lymphadenopathy

Paediatric-History taking and physical examination of a patient with fever and lymphadenopathyCreated OnApril 23, 2020Last Updated OnApril 23, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking and physical examination of a patient with fever and lymphadenopathy < All Topics Table of Contents History taking: Ask about patient’s data: name, age, gender Ask about history of presenting illness Swelling Onset, site, size and progression, shape, pain, redness Presence of rash? – measles, rubella, Kawasaki disease, Lyme disease URTI symptoms – measle, rubella Hx of myalgia, arthralgia, headache – Lyme disease, dengue fever Constitutional symptoms: loss of appetite, loss of weight, fever, night sweats? – leukemia, lymphoma Easy bruising, bleeding tendencies, frequently getting sick, anemic symptoms – leukemia Hx of red watery eyes, injected pharynx, red lips, strawberry tongue, swelling of palms and soles, rashes, lymphadenopathy – Kawasaki disease Hx of malar flush, photosensitivity, oral ulcer, joint pain/ swelling – SLE Exposure to insects/ animals Hx of sick contact Recent travel? Ask about antenatal history Ask about birth history Gestational age at delivery? Birth weight? Mode of delivery? Hx of postnatal complications? Ask about vaccination history Completely/ incompletely/ unimmunized? – MMR vaccine? Ask about feeding history Type of food/ milk Frequency and amount being fed Unpasteurized animal milk – brucellosis Undercooked meat – toxoplasmosis Any reduced oral intake/ loss of appetite Known food allergy Ask about developmental history Ask about past medical history Any underlying chronic illness causing immunosuppression Ask about drug history Medication that can cause lymphadenopathy – penicillin, phenytoin, lamotrigine, sulphonamide, cephalosporins, Any drug allergy? Ask about family history Family hx of malignancy/ autoimmune disease Chronic familial diseases? Ask about social history Living environment? Parent’s financial status and educational level Is the child taken care by a babysitter? If yes, how many children is the babysitter taking care? Any sick contact? Physical examination: Anthropometric measurement: weight, height, BMI, head circumference Vital signs: temperature, BP, pulse, respiratory rate, spO2 General Does the child look cachexic? (malignancy) Pallor? (leukemia, SLE) Is the mass a lymph node? Lymph node examination Size Unilateral/ bilateral Localized/ generalized Generalized: infectious mononucleosis, HIV, military TB, SLE, medication Location Cervical Oropharyngeal infection Scalp infection Viral infection: EBV, CMV Toxoplasmosis Mycobacterial lymphadenitis Kawasaki disease (unilateral cervical LN...

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