Paediatric-History taking & Physical examination of Tuberculosis

Paediatric-History taking & Physical examination of TuberculosisCreated OnApril 23, 2020Last Updated OnApril 23, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of Tuberculosis < All Topics Table of Contents History taking: Ask about patient’s data: name, age, gender Ask about history of presenting illness Fever Grade? Pattern? Associated with chills and rigors? Cough Duration Dry/ productive Post-tussive vomiting? Haemoptysis? Shortness of breath/ rapid breathing ± recession Night sweats Weight loss History of contact with suspected/ diagnosed TB patient (living in the same household/ frequent contact) Poor feeding/ lethargy Symptoms of extrapulmonary TB TB lympadenitis: painless lymphadenopathy Pleural TB: shortness of breath, pleuritic chest pain TB pericarditis: fever, chest pain, shortness of breath, pedal edema TB meningitis: headache, stiff neck, altered behaviour, seizure TB bone or joints: joint swelling/ stiffness (synovitis), localized bone pain/ swelling (osteomyelitis) TB peritonitis: abdominal pain, distention, decreased appetite, weight loss Gastrointestinal TB: abdominal pain, diarrhoea, GI bleeding Renal TB: haematuria, dysuria, flank pain Genitourinary TB Military TB Ask about antenatal history Maternal HIV – on antiretroviral therapy? Mode of transmission: transplacental, intrapartum, breastfeeding Ask about birth history Gestational age at delivery? – prematurity Birth weight? Ask about vaccination history BCG vaccination given at birth Ask about past medical history History of TB infection? – When? What treatment was given? Any complications? Diagnosed HIV? – risk of TB is higher in HIV-infected children Any underlying chronic illness causing immunocompromise Ask about drug history Long term use of steroids/ immunosuppressive drug Any drug allergy? Ask about family history Any similar symptoms seen in family members? Chronic familial diseases? Ask about social history Living environment? – Crowding? Poor ventilation? Physical examination: Anthropometric measurement: weight, height, BMI, head circumference Assess for failure to thrive General Vital signs Temp: may be high or grade fever Pulse: rate (increased with fever/ shock), volume, rhythm BP: hypotensive if in shock Respiratory rate: increased Nutritional status: well build? Thin build? (evidence of weight loss?) Conscious? Alert? Orientated? Altered mental status? Presence of BCG scar Any palpable lymph nodes – TB lymphadenitis (scrofula) Any gibbus – TB spine Respiratory system examination Inspection Respiratory distress: flaring of nose, use of accessory...

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