هذا الكتاب جابوا الحالات الجايني منه مطبوعه جاهزه تقرأها وتشخص ومناقشة عليها

هذا الاوسكي معه كل حالة جايني أو اوبس تنسال منهن
- contraception بالتفصيل عنه
-gynaecology instruments
-obstetrics instruments.

Quick Summary in Pediatric History Taking

▪️Personal History:
1-Name, age and gender.
2-Residence, e.g. from Dhamar and lives there.
3-Number or order among his siblings.
4-Date of admission and through what.
-May be as OPC or ED or as a referable case from a private clinic or hospital.
5-Source of the information or the informant.

💬Example, Comment:
-A 6 month old male infant, Ali Saleh Ahmad, from Jahran and lives in Maaber city. He is the 3rd kid in his siblings.
-DOA: The patient was admitted to hospital on Wednesday in the 1st of December, 2022 through ED at 7:00 a.m. Or say: the patient was admitted one day ago..etc
-The informant is the infant's mother.
-The date of history taking is in 2-12-2022 on Thursday.


▪️Chief complaint:
-As usual with duration, can be three.

💬Example:
-The patient was suffering from Cough and Fever 2 days prior to admission and difficulty of breathing 1 day before admission.
Or " better"
-Fever,Cough 2 days
-Difficulty of breathing 1 day.

▪️History of present illness:
1-Last time when the patient was healthy.
-If the patient is less than 3 year-old you say the patient started suffering ,but if more you can say started complaining.
2-The first symptom that appeared .
3-Analysis of the each complaint.
4-Associated symptoms with analysis.
5-Significant review of other symptoms to support your Dx & narrow your differential diagnosis or to look up for complications.

💬Example:
-The patient was quite well till 2 days back when he started suffering from fever which was gradual in onset, low grade, intermittent in course, 3- 4 times /day each one remains 1-2 h, relieving by medication and cold fomentations or pads. No aggravating factors, interfering with patient's sleep. Not documented "يعني ما قاستها الأم"
-Associated with Cough which was gradual, with progressive course 2 days duration, aggravated in cold weather, no relieving factors, not productive interfering with infant's sleep. Not related to position. Yesterday the fever became high grade or increased in severity according to mother saying, continous, not relieved by medication and cold fomentations. The cough became productive with small amount sputum white color, no blood. Also the patient suffered from difficulty of breathing, gradual in onset, 1 day duration, progressive in course, no relieving or aggravating factors and it's interfering with sleep.
-There's no history of noisy respiration, no cyanosis, no sweating, .. etc

Note:
-You should ask and comment on hospital stay, like investigations done, procedures performed, treatment given and if new symptoms developed, and the current condition of the patient.
-Systemic review:
Including general and systemic:
Should write them especially the important symptoms related to the case in each system even when negative.
-Note:
بعض الدكاترة مثل الشهاري مايعجبه تقول: The baby was well،تكتب رأساً :
The condition started as...etc
▪️Past History:
-Like any history, including drug and trauma hx.

▪️Perinatal History:
-هذا تذكره لوكان أقل من سنتين،و كذلك لو كانت الحالة Neurological مثل CP أو Endocrine في أي عمر.
▫️Prenatal or Antenatal hx:
- Mother age at pregnancy.
-Antenatal Care : antenatal Visits , Folic acid supplementation.
-History of fever and rash and if present ask about the trimester.
-يهمنا لوفي TORCH infections خصوصاً في الشهور الأولى تسوي congenital diseases.
-History of maternal diseases during pregnancy such DM, PIH..etc
وكذلك لو معهDM؛ لأنه قد يسوي CHD.
-History of drug intake and ask if she knows the name, it may be teratogenic.
-History of maternal exposure to radiation, teratogenic.
-History of tetanus vaccination "important to know the doses".

💬Example:
-The mother is Para 3 plus 0 and her age at pregnancy was 26 year-old.
-Regular antenatal care, a visit per month, had folic acid and iron supplementation.
-No history of fever and rash, no history of maternal diseases during pregnancy like DM or HTN, no history of drug intake apart from some vitamins and the above mentioned supplements. No hx of exposure to radiation. No history of tetanus vaccination.

▫️Natal History or Birth hx:
-If the baby is full term or preterm or post-term.
-Delivery: ask if:
Vaginal:
1-Spontaneously or induced? if induced, why?
2-Place: at home , or hospital or private clinic.
3-Performed by: Doctor or midwife or nurse or her relative if at home.
4-Expulsion of baby: spontaneously or by using forceps or vaccum extractor if she knows.
5-Duration of labour, ask if prolonged.
-Do not say normal unless the criteria
of normal labour are fully applied.

CS, ask about the indication and type of anesthesia.
-Ask about bleeding, PROM, prolonged labour, fever during delivery to exclude chorioamnionitis.
-The outcome, is crying immediately or not, color, if any trauma, weight if mother knows. Apgar score.
-مافي أم عارفة لذلك بلا هذا السؤال.

💬Example:
-Full term baby, spontaneous normal vaginal delivery at home by relative with no complication to mother and baby.
-The outcome was a single male baby crying immediately, with pinkish color and the wt was not documented.

▫️Postnatal history:
-Did baby need resuscitation or not? Is he admitted to NICU or incubator or not? If yes, ask about duration, any procedure, outcome.. etc
-History of passage of urine and meconium. "You should know the normal time and DD if delayed".
-Hx of cyanosis, jaundice, seizures, respiratory distress, infection"umbilical stumb ", bleeding " vit.K ", congenital anomalies, or birth injuries.

💬Example:
-The baby was healthy and did not need resuscitation or admission to NICU or incubator. Urine was passed by the second day and meconiuum or stool by the 1st day.
-No history of cyanosis, jaundice, seizures, respiratory distress, infection"umbilical stumb ", bleeding , congenital anomalies, or birth injuries.

▪️Nutritional history:
-Time of the first feeding after delivery.
-الدكتور الصلوي يسأل متى تبدأ ترضعه الأم، قال إذا كانت ولادة طبيعية تبدأ as soon as possible أو نص ساعة إلى ساعة، إذا كانت CS حوالي ٤ ساعات تبدأ.
-Type of feeding either breast or formula feeding or it's mixed.
1-Breast feeding:
-Way of feeding: from one or both sides.
-Frequency: Regular "at least every 3 hours" or on Demand "when baby cries".
-Duration of each feed: e.g. 10-15 minutes on each breast.
-Behavior of the baby after each feed: Is he satisfied or not? Is he sleeping or return to pre-feeding state? Not crying, trying to suckle again or suckling finger?
-Duration of exclusive breast feeding.
-Any problem with feeding" large nipple, soreness of nipple , others".
-You should explain to the mother the technique of breast feeding: proper infant attachment.خصوصاً د.البهلولي.

2-Formula feeding:
-Indication: is it complementary or supplementary or substitutive?
-When started? onset.
-Type of milk or type of formula use "lactose free, soy milk formula, others".
-Frequency of feeding and average duration of each feeding.
-Amount of milk per feed and is baby satisfied or not?
-Concentration of milk, e.g. amount of powder milk given for how much amount water.
-Is there any complications occurring after introduction of formula feeding such as diarrhea, colic, vomiting.. etc
-Way of sterilization of the bottle "boiling, washing, brushing".
Note: animal milk such as that of cow or goat is called unmodified formula while that of powder is called modified.
3-Weaning:
-Ask when started, type of food introduced and if there's any complication to any sort of food.

💬Example:
-The feeding started about 1/2 hour after delivery from mother breast with no pre-lactational feeding.
-The baby was feeding on demand from both breasts, of each feed was about 15-20 minutes. Then the baby after feeding released breast spontaneously and got sleeping with no crying or trying to return suckling again.
-No weaning till now and no introduction of supplemental vitamins or anything.

▪️Immunization or Vaccination Hx:
-Vaccinated up to date according to Yemeni vaccination schedule protocol if less than 18 months.
-Completely vaccinated... etc if more than 18 months.
-Last vaccine
-Not vaccinated, why? you must ask why." You should educate the mother about the significance of vaccination".
-Any complications "fever, pain, convulsion, rash, excessive crying", e. g. pertussis vaccine causes (convulsion, shock).

💬Example:
-Vaccinated up to date according to Yemeni vaccination protocol. The last vaccine visit was when he is 4th months and given the 3rd dose of oral polio and two injections which may be the pentavalent and pneumococcal vaccines.
or
-He or she didn't get any vaccine, because the facilities or health care center is far as the mother said.
or
-Not vaccinated at all because of the patient's family beliefs.

▪️Developmental history:
-Gross motor (sit, stand, walk) or crawl.
-Fine motor (Grasp, move object from hand to hand, etc.)
-Social (smile, laugh, etc.).
-Speech, Vision, Hearing.
-Urination and defecation control."not necessary".

💬Example:
-Regarding to grass motor milestones:
The baby started to sit without support, with round back at 6 months "now".
-Regarding fine motor and vision:
Palmar grasp of objects; reaches for toys with one-hand approach and grasp.
-Regarding social, speech and language:
Baby started recognizing his mother and saying Monosyllabic babbles" consonant sounds".
Or say up to date.

▪️Family History:
-Parents, mother and father:
age, health or chronic disease, similar condition, consanguinity" you should know the degrees of consanguinity and its significance ", occasionally blood group.
-Siblings: number, age, sex, similar illnesses, disabilities, and significant medical history of all siblings.
-Significant events in the family: abortion, still birth, hx of death among the parents or siblings; if so, ask about cause, age, and date of death. Also Illnesses that run in the family.

💬Example:
-The mother is 27 year-old and the father is 33 year-old or "unknown". Both of them have good health with third degree consanguinity. No hx of chronic diseases or similar condition.
-Siblings, 5 year-old female and 3 year- old male ,both have good health and no hx of similar condition.
-No hx of significant events in the family such abortion..etc.

▪️Socioeconomic History:
-Level of education of both parents occupation, and smoking.
-Family income" you can obtain it indirectly from occupation and housing ".
-Housing and living conditions:
Do they own or rent their home?How many rooms does the home have? Is it overcrowded? Ask about the number of people living in the patient’s house.
Ask about ventilation and sanitary conditions.
-Water supply:
-Is it deep water?
- مياه جوفية يعني من البير إرتوازي أو من المشروع، الدكتور يدقق في هكذا أشياء.
-Is it superficial?
-مياه سطحية مثل البير اللي هي يدوية أو من الوايت ؛ لأنه يهمنا لو كان contaminated ،مثل لو في AGE كالـ infection that's water-borne مثل الكوليرا وغيرها.
-Animal contact in relation to the onset of illness.
-Sometimes you can ask about history of travelling.

-Lastly the summary, mention the demographic data of the patient with the important positive findings and significant negative ones.

Best wishes.✨

بعد الدكتور الصلوي بعض الكلام.

Clinical Pediatrics History Taking and Examination, Aruchamy Labhmanaswamy.

مشاركة 'essential clinical skillاطفال.pdf'

راوند الأطفال، هذا الكتاب قوة خصوصاً في الـ Examination، وحق د. النجار مهمات و ينفعين قوي، حق الـ Diagnostics والـTherapeutics.
بالإضافة إلى الأشياء الروتينية ناصر جمال و Baby Nelson ومحاضرات الدكاترة.

وكذلك ڤيديوهات الدكتور الليبي عبدالرحمن الجعكي.