Paediatric-History taking & Physical examination of Cushing’s syndrome

Paediatric-History taking & Physical examination of Cushing’s syndromeCreated OnApril 29, 2020Last Updated OnApril 29, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of Cushing’s syndrome < All Topics Table of Contents History taking: Ask about patient’s details: Name, age, gender Ask about chief complain & relevant history of presenting illness Excessive weight gain Symptoms of OSA: snoring, daytime somnolence, observed episodes of apnea Skin changes: purple stretch marks, poor wound healing, easy bruising Hirsutism (♀): acne, balding, male pattern facial hair growth Breast enlargement (♂) Difficulty climbing up the stairs, raising arm – prox. muscle wasting Mood changes Urinary symptoms: dysuria, loin to groin pain, haematuria, polyuria (DM) Rule out other causes of edema, eg. Heart failure, liver failure, CKD Ask about menstrual history (♀) Irregular menstrual cycles, amenorrhea/ oligomenorrhea Ask about past medical history Chronic illness requiring long term steroid use Newly diagnosed DM or HT? Ask about drug history Use of corticosteroids drugs (mode of administration, dosage, duration, whether symptoms appear after usage of corticosteroid drugs) Intake of traditional medications/ supplements (duration, amount, how frequent, whether symptoms appear after ingestion) Ask about family history History of malignancy? Physical examination: Vital signs Hypertension General Obese build – measure height and weight for BMI Central obesity with purplish abdominal striae Fat deposition at temporal, supraclavicular, episternal, dorsal cervical fat pad Skin: thin, ecchymoses, poor wound healing, facial acne, facial plethora Gynecomastia in males Thin limbs, muscle wasting Look for edema Systemic CVS: deviated apex beat in hypertension, signs of heart failure (bibasal crepitations, raised JVP, tender liver, hepatomegaly, murmur) Assess Mallampati score if OSA is suspected GIT liver disease: hepatomegaly, ascites, stigmata of chronic liver disease (clubbing, palmar erythema, Dupuytren’s contractures, gynecomastia, spider nevi, caput medusa) kidney disease: palpable, ballotable kidneys? Clitoromegaly in ♀ Assess proximal myopathy Difficulty arising from low chair/ squatting position Difficulty raising arms CNS – other causes of proximal weakness Eye – to look for steroid induced glaucoma/ cataract Mini mental state examination (MMSE) Taken from Doctrina Perpetua guides on Paediatric

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