Pediatric Osce History and Communication Checklist-1

Content
History taking checklist

General History taking checklist page 4
1. Generalized ,facial , lower limb edema history taking
2. Fever history taking
3. Skin Rash history taking
4. Lymphadenopathy history taking
5. neck swelling history taking
Neonatal history taking page 11
1. Neonatal cyanosis history taking
2. Projectile Vomiting (infant) history taking
3. Neonatal Jaundice history taking
4. Neonatal seizure history taking checklist
Cardiac history taking page 15
1. Syncope history taking
2. Palpitations history taking
3. Chest pain history taking
Respiratory history taking page 19
1. Cough history taking
2. Wheezy infant history taking
3. Br Bronchial asthma history taking checklist
4. eathlessness history taking
5. CFhistory taking
Gastrointestinal history taking page 26
1. Vomiting history taking
2. Chronic diarrhea history taking
3. Constipation history taking
4. Faecal Soiling history taking
5. Abdominal mass history taking
6. Hepatomegaly history taking
7. Splenomegaly history taking
8. Jaundice history taking
9. Recurrent abdominal Pain history taking
10. Upper gastrointestinal Bleeding history taking
11. Lower gastrointestinal Bleeding history taking
12. Obesity history taking
13. Eating disorders history taking
Nephrological history taking page 40
1. Enuresis History taking cheklist
2. Red urine history taking
3. Relapsing nephrotic syndrome history taking
Neurological history taking page 44
1. Seizure history taking
2. Febrile seizure history taking
3. Headache history taking
4. Floppy infant history taking
5. Ataxia history taking checklist
6. Abnormal Movement history taking
Neurodevelopment history taking page 51

1. Global development delay history taking
2. Speech delay history taking
3. Cerebral palsy (new case) history taking
4. Cerebral palsy(known case) history taking
Locomotors history taking page 56

1. knee joint pain history taking checklist
2. Limping history taking
3. Joint swelling /Stiffness(arthritis) history taking checklist
4. Rheumatological history taking
5. Joint swelling /Stiffness history taking
6. knee joint pain history taking
hematological history taking page 60

1. Pallor history taking
2. Bleeding tendency history taking
3. Sickle cell disease crisis history taking
endocrine history taking page 63

1. Short stature history taking
2. Tall stature history taking
3. precocious puberty history taking
4. Delay puberty history taking
5. Ambiguous gentile history taking checklist
6. Thyroid Problems history taking checklist
7. DM history taking
Communication (explanation and consultation) checklist page 70

General History taking checklist (Preparation before entrance)
1. Introduction (Initial approach to the patient ) (Interview)

(Greeting ,Introduce him/herself, explain what he/she will be doing)
2. personal data , Refer to the child by name
3. start point with the GP referral letter and if the child currently admitted or no. (Conduct of Interview)
4. Open question about the chief Complaint
 “So what’s brought you in today?” or “Tell me about your kid symptoms”
 Use parents’ own words in chronological order with duration for each.
5 : history of present illness
 if infant or condition related to birth start with perinatal history.
 if acute enquire as to when patient was last entirely well?
 If chronic known illness ask about time of Dx.
 Ask about
 when it first began
 mode of onset(Acute or gradual)
 duration
 Frequency (1st time or frequent)
 Course (Intermittent or continuous)
 progression ( worse/better or same )
 Aggravating or Relieving factors including treatment?
6. Associated symptoms related to complain system and effect on normal activities
 fever, sweating , activity (irritable, lethargy), feeding (poor feeding ,Vomiting)
 Stools (loss motion, constipation, weight gain/loss, FTT) , sleeping (Poor sleeping)
7.Summarising patient presenting complaint and Focused history (goal oriented ) or (routine history)
 Once you have summarised, ask the patient if there’s anything else that you’ve overlooked.
 Continue to periodically summarise as you move through the rest of the history.
 Signposting involves explaining to the patient; “Ok, so we’ve talked about /“Now I’d like to
8. Systemic review: Choosing which symptoms to ask about depends on the presenting complaint
 CVS – infant feeding / sweating / cyanosis / pallor / SOB
 RS – runny nose / cough / wheeze / SOB / activity limitation / snoring
 GI – appetite / diet / vomiting / pain / abdominal distention / bowel habit / stools / toilet training
 CNS – headaches / fits / hearing / vision / weakness / rash
 Urinary – pain / color / frequency / training
 MSK - limp / limb pain / joint swelling / pain
9. Past medical and surgical history (Further related history)
 similar condition ,previous admission , previous surgeries, blood transfusion , allergy and drug history
10. Antinatal history
11.nutritional history (Significant in child < 2 years , anemic or malnourished).
12. Developmental history (Any concerns)
13. Immunization history (check vaccination card )
14. Family History: (draw a family tree) (Important in chromosomal, hereditary, infectious diseases)
(consanguinity, Similar illness , Chronic disease ,history of family or genitical diseases )
15 . Socioeconomic history .
16. Ask relative if he has Any question
17.thanks (Finilazation and reconstruction)
Presentation history checklist (DDx and management plane)
1.look confidently to examiner eyes, speak loudly ,listen carefully
2. Brief introduction
• personal data , and current state
• referral /admission cause
• active main problem
• other problem in priorities
3. DDx
• Set most likely Dx initially
• Chose according to child condition not general DDx
• Common is common , not mention very rare disorder
• If don’t know mention DDx , say will seek senior help or you will review the subject and come back again
4. Problem list and suspected diagnosis
• Set main problem worrying parent first
• Known Dx if there
• List the problem by priorities
• Social and psychological impact of problem on child and family
• Expected outcome or complication
5. Management plane.
• Mention if need Admition ,Refer ,Senior help
• Mention if need MDT
• Advice and reassurance if valid
• Investigation if required
• Medical management
• Surgical management
• Package of education
• F.up
Edema history taking checklist
1.Initial approach to the patient (Greeting ,Introduce him/herself, explain what he/she will be doing)
2.personal data , Refer to the child by name
3. Open question about the chief Complaint (generalized edema / swelling)
4 : onset , course
 onset and duration : when start (acquired ,renal ,liver /congenital ,Turner's or congenital NS).
 Generalized or localized
 If Generalized(anasarca)
 where start and where extension(orbits/ hands, abdomen, back )
 Biting (liver ,renal ,cardiac) or non biting (angioedema, hypothyroidism)
 aggravating factor(drugs/foods in allergic and angioedema)
 dependency ,change with daytimes (standing in legs / lying in sacrum) (early morning in face / mid day in legs)
 If localized (periphral)
 site :where start (hands, legs) (uni/bilateral)
 Biting (liver ,renal ,cardiac)or non biting (infection, lymphedema, thrombosis, arthritis ,Allergic, Insect bite)
 painless(liver ,renal ,cardiac, lymphedema, angioedema ,Allergic) or painful (infection, thrombosis, arthritis )
 Extension and grade (dorsal foot ,mid leg , up to knee ,whole leg )
 ask if preceded by URTI or skin rash
 ask if recently received IV fluid or allergen exposure
 ask if recently has trauma ,insect bite or local skin infection
5. Associated symptoms (fever,irritable,lethargy,poor feeding ,Vomiting , loss motion, constipation,weight gain/loss, FTT,Poor sleeping)
6. Systemic review:
 Renal (colure and amount of urine ,dysuria, loin pain ,urgency ,frequency)
 CVS (feeding difficulty, diaphoresis, dyspnea on exertion, ,palpitation ,shortness of breath,cyanosis, orthopnea )
 GIT and liver (jaundice, failure to thrive, steatorrhea, or abdominal pain,abdominal distention,stool colour)
 hematology: (pallor ,bleeding tendency ,l.adenopathy , bony ache )
 Respiratory (URTI ,cough , Presence of blood in sputum)
 CNS (headache, convulsion (
 Endocrine:( short stature ,delay puberty ,obesity)
 dysmorphic face and congenital malformation
 skin and hair: skin rash ,itching ,dermatitis ,hyper/hypopigmentation ,coarse hair,l.adenopathy
7.Nutritional history
 If it is infant: breastfed or bottle fed, type of formula used, how many meals,poor sucking, refusal to eat, prepareation
 weaning (when, what type of food she introduced)
 If table food: quantity of food, quality
8. past history
 Same illness ,food and drug allergy ,Drug (steroid ,ACEI) ,CHD , liver dsisease
 Weight gain and tight-fitting clothes and shoes.
 malignancy ,chemo Rx , previous surgeries, pelvic trauma,joint problem, eczyma ,trauma
9.perinatal history (if early neonatal odema)
 Maternal drug ingestion ,infection (TORSCH) ,hepatitis B and C
 1 urine voiding ,hand and feet edema, TSH screen , prolonged neonatal jaundice
st
 congenital and syndromic lymphedema

10. Family History: (consanguinity, F/H of recurrent angioedema, Similar illness , Chronic renal disease ,allergy)
11. Immunization history
12.Developmental history (delay in syndromic lymphedema)
13. Socioeconomic history (income, housing ,trees ,animal ,travel to endemic area (filiriasis)
14- Ask the relative or patient if he has any question or information
15-Thanks
16.Presentation
 Brief introduction (personal data and current state /active main problem other problem in priorities(
 DDx initially and most likely Dx initially
 List the problem by priorities /Social and psychological impact of problem on child and family
 Management plane. Investigation/ Medical and Surgical management/ MDT/ Refer Advice and reassurance/ education / F.up
Fever history taking checklist
1.Initial approach to the patient

3. Open question about the chief Complaint (Fever)
4. analyze fever
 Onset when start
 continuous or intermittent (at night)
 frequency (biphasic/leshmaniasis)
 documented or not /grade
 relieving factor : response to water compressors and antipyretics.
5. Ask if recent vaccination ,dental eruption, travel ,ticks or mosquito bites
5. Associated symptoms (skin rash ,sweating ,rigor, chills, peripheral cyanosis, convulsion ,irritable , lethargy, poor feeding
,Vomiting , loss motion, constipation,weight gain/loss, FTT,Poor sleeping)
6.Systemic review:
 Respiratory (sore throat ,cough, ear ach or discharge )
 GIT (vomiting , loss appetite , diarrhea ,abdominal pain , jaundice, oral ulcer, stomatitis)
 Renal (dysuria, loin pain ,urgency ,frequency (
 CNS ( decrease activity ,convulsion , irritability , headache, vomiting, photophobia, IOC, neck rigidity)
 CVS: (DOB, cyanosis )
 Ortho ; skin rash , joint pain and swelling
7. past history
 Past medical illness : chronic illness ,murmur , UTI , previous admission
 Antenatal history ask about PROM, maternal fever, maternal UTI, birth weight, abortion).
8.nutration history (ask if ingest unpasteurized raw milk ingestion /brucellosis)
9. Immunization history (uptodate/no)
10. Family History: (any febrile illness in family member, Chronic disease )
11. Socioeconomic history (contact with ill pt at nursery , school) (animal at home)
12.Ask the relative or patient if he has any question or information
13.thanks
14.Presentation
Skin Rash history taking checklist
3. Open question about the chief Complaint (Skin Rash)
4 : onset
• duration
• Location (where did the rash begin ?
• Character: describe lesions as they initially appear and their evolution itching; scaling; crusting; weeping; blistering
• distribution how did it spread {face, palms, soles involvement, any change in hair, nails or teeth?
• association , discharge, bleeding, itching, pain, blanching
• Aggravating Factors: scratching; skin contact with irritant, (poison ivy, wool, etc) ,sun eposure.
• Ask about recent febril illness
5. Associated symptoms (fever ,cough, coryza, conjunctivitis, loss of appetite, decreased activity, irritability, weight loss ,LN)
6. Systemic review:
 CNS (convulsion ,large head)
 GIT vomiting , diarrhea, abdominal pain (FMF/IBD) ,pallor, jaundice, changes in tongue (scarlet fever)
 Renal (colour and amount of urine /HSP,dysuria, loin pain ,urgency ,frequency, polyuria)
 Heamatological (bleeding tendency,bony ache ,joint pain and swelling ,itching)
 CVS (feeding difficulty,chest pain, shortness of breath,L L edema ,palpitation )
 Respiratory (URTI ,cough /measles , Presence of blood in sputum, wheeze)
 Endocrine:( tremor, flushing, sweating, neck swelling)
 Ortho: joint pain, swelling, redness (rheumatic diseas) ,photosensitivity (SLE).
 slapped cheeks: erythematic infectiosum.
 Oncology : weight loss, anorexia: (malignancies)
7. past history (skin disorder, atopy,asthma,recent URTI,if rash is transient/seasonal ,bleeding tendency, drug allergy )
9. Immunization history (MMR ,varicella)
10.Developmental history (neurocutanous lesion ,NF ,TS ,SWS)
11. Family History: (consanguinity,skin disease, atopy - asthma, seasonal allergy, drug or food allergy, atopic dermatitis)
12 . Nutritional history (cow milk allergy /food allergy)
13. Socioeconomic history (housing , exposures to dusts,chemicals, and pets.)
14 . travel history or contact
15.Ask the relative or patient if he has any question or information .
16.thanks
17.Presentation
Lymphadenopathy history taking checklist
1.Initial approach to the patient (Greeting ,Introduce yourself, explain what you will be doing)
3. Open question about the chief Complaint (Lymphadenopathy or neck swelling )
4- onset , chch , course
 When and where did it begin? duration ,Sites -generalized or local /neck (mid/lat),
 progression: Change in size, color
 painful or no
 mobile or not
 number
 Recent sore throat, cough, or upper respiratory symptom
 Recent animal bite , scratches or trauma
5. Associated symptoms (fever , night sweats,cough,Hemoptysis , loss of appetite, weight loss ,sore throat ,
Odynophagia , caries , bone pain ,arthritis ,skin rash or conguctivitis )
6. Systemic review:
 Respiratory (URTI ,cough , hemoptysis, otalgia, deafness, hoarse, snoring at night, nasal speech )
 GIT (Odynophagia ,vomiting ,abdominal distention, abdominal pain , pallor, jaundice, constipation , mouth ulcer)
 CNS (LOC,convulsion,increased ICP,motor or sensory symptoms,cranial nerve involvement, abnormal body movement )
 Renal (colour and amount of urine ,dysuria, loin pain ,urgency ,frequency, polyuria,)
 Heamatological (bleeding tendency,bony ache ,joint pain and swelling ,skin rash ,itching)
 CVS (feeding difficulty, Exercise intolerance, chest pain, shortness of breath, orthopnea ,L L edema ,palpitation )
7. past history (similar condition ,previous admission ,surgeries, bleeding tendency, joint problem , allergy, blood
transfusion, Irradiation ,recurrent infection and drug history-induced: phenytoin, allopurinol, INH. )
8.perinatal history (if neonate)
9. Immunization history - for BCG: TB
10.Developmental history (delay in storage disease)
11 . Family History: (Similar illness , Chronic disease ,History of malignancy or respiratory disease, TB)
12 nutritional history (raw milk ingestion)
13. Socioeconomic history (income, housing ,education of family, animals as pts in house)
14. travel history –TB endemic area
15-Ask the relative or patient if he has any question or information .
16.thanks
17.Presentation
Neck swelling /mass history taking checklist
3. Open question about the chief Complaint (neck swelling /mass)
4- onset , chch , course
 When did it begin? Age / duration
 where Sites (mid/lat),other part of body is involved
 progression: Change in size, color
 painful or no
 mobile or not
 number ,other part of body is involved
 Recent sore throat, cough, or upper respiratory symptom
 Recent animal bite , scratches or trauma
5. Associated symptoms (fever ,chills, night sweats, cough,Hemoptysis ,bone pain, loss of appetite, fatigue, weight loss
,skin rash or conguctivitis)
6 .Head and Neck symptoms
 Chronic unilateral nasal discharge or bleeding /otalgia / Hearing loss (unilateral)
 Hoarse ,Odynophagia, dysphagia, globus sensation
7. Systemic review:
 CNS (LOC,convulsion,increased ICP,motor or sensory symptoms,cranial nerve involvement, abnormal body movement )
 GIT (Odynophagia ,vomiting ,abdominal distention, abdominal pain , pallor, jaundice, constipation , mouth ulcer)
 Heamatological (bleeding tendency,bony ache ,joint pain and swelling ,skin rash ,itching)
 Respiratory (URTI ,cough , hemoptysis, otalgia, deafness, hoarse, snoring at night, nasal speech )
7. past history (similar condition ,previous admission ,Irradiation surgeries, bleeding tendency, joint problem ,
allergy, blood transfusion, Irradiation ,recurrent infection and drug history-induced: phenytoin, allopurinol, INH. )
10.Developmental history (delay in storage disease)
11 . Family History: (Similar illness , Chronic disease ,History of malignancy or respiratory disease, TB)
12 nutritional history (raw milk ingestion)
13. Socioeconomic history (income, housing ,education of family, animals as pts in house)
14. travel history –TB endemic area
15-Ask the relative or patient if he has any question or information .
16.thanks
17.Presentation
Neonatal history taking checklist
Neonatal cyanosis history taking checklist
3. Open question about the chief Complaint (bluish discolouration of lips,tongue,or both +_ skin )
4. Onset of the cyanosis (sudden ,gradual )
 Age of onset (since birth )
 sit of cyanosis (lips,tongue,or both +_ skin /upper or one side of body)
 course (progressive,regressive,intermittent )
 with or without RD
5. Aggravating factors (feeding ,crying ,cold environment ), relieving factors (rest ,special position ,oxygen )
6. Systemic symptoms (fever , sweeting, loss of wt ,loss of activity , poor feeding ,sleep pattern)
7. Systemic review:
 CVS (feeding difficulty, effort intolerance , shortness of breath, orthopnea , palpitation)
 CNS (seizure , HIE ,flopness, poor feeding, apnea )
 respiratory system (RD ,cough, choking, wheeze, noisy breathing ,sleep apnea )
8.perinatal history
 Prenatal :(Torch infection, HTN,DM, maternal drugs ingestion /narcotic/magnesium ,poor fetal movement …. (
 Natal (Prematurity , post term , cesarean and GA ,asphyxia ,need for resuscitatioin ,meconium aspiration )
 Post natal (admission to ICU ,need for oxygen ,ventilator support ,fever iv neonatal period , Congenital defects)
9. Family History: (consanguinity ,sibilant with CHD ,myopathy, infant death, Chronic disease )
10. At the end to ask if there is any more questions
11. Thanks
12.Presentation
Projectile Vomiting (infant) history taking checklist
3. Open question about the chief Complaint (Vomiting) then ask about its charastristic
• Age of Onset and Duration: when was your vomiting started? Acute or chronic
• Time : posfeeding
• color : bilious / nonbilious/bloody
• Frequency: how many times per day
• Nature: effortless, forceful (onto child or parent), projectile (several feet away)
• Volume: dribble onto clothes or full stomach
• Relation to feed and posture
4. Associated symptoms (fever , constipation+ dryish nappies from dehydration , abdominal distention , jaundice, Weight loss)
5. Systemic review:
6. postnatal history: (APGAR score ,meconium passage ,neonatal screening , haemorrhage or birth injury, congenital
abnormalities , number of days in hospital, NICU admission, birth and discharge weight)
7 . drug history (macrolide ,digoxin , opiates ,theophylline)
10. Family History: (Similar illness)
11 . feeding history breastfed or bottle fed, type of formula used, how many meals, quantity of milk, how she prepare the
formula, weaning (when, what type of food she introduced) (feeding problem/cow milk allergy)
14.thanks
15.Presentation
Neonatal Jaundice history taking checklist
(Greeting ,Introduce yourself, explain what you will be doing)
2.personal data
3. Open question about the chief Complaint (yellowish discolouration of skin ,sclera or mucus membrane )
4. Perinatal history
Prenatal :
 ethnicity? (Asians, and Blacks have some increased risk)
 Primi or no /abortion
 Maternal blood group /if RH –ve ask about anti D
 Maternal illnesses HTN, DM or Torch infection
 Results of antenatal screening tests (HAVsAg )
 Maternal medicine or drug intake
Natal
 Preterm ,small for gestational age or post maturity, twins
 mode of delivery ,instrument uses (Birth trauma with bruising or cephalohematoma)
 Delayed cord clamping (could indicate polycythemia)
Post natal
 Neonate blood group ….
 admission to N ICU ,need for oxygen ,ventilator, blood transfusion ,fever, iv AB, surgery ,TPN.
 if mother +ve for HBVsAg /results of newborn tests (HBV vaccine ,HBIG)
 Delay in passage of meconium
 Results of newborn screening tests (galactosemia ,TSH) ,TORCH
5. History of Present Illess (characteristic of the Jaundice)
• onset (Age < 24hrs/>24 hrs old age ) (sudden ,gradual )
• Duration (acute (<1 week), prolonged (> 3 weeks)
• sit of Jaundice ( skin, sclera , mucus membrane )
• progression of jaundiced skin (progressive, regressive, intermittent )
• urine and stool color (dark, tea coloured urine or acholic (pale) stools)
6 . General health
• General activity: irritable? lethargic?
• Infections or fever?
• Feeding: breast milk or formula?
• Current weight compared to birth weight. Gaining weight appropriately?
• Number of wet diapers per day? (Indicator of hydration status)
7 . symptoms of kernicterus : ( consciousness, hearing changes, seizure, hyper-hypotonia)
8. Systemic review:
 Dysmorphic face
 Heamatological (bleeding tendency)
 CVS and respiratory system (feeding difficulty, shortness of breath , cough,choking, noisy breathing ,sleep apnea)
 Skin (rash or pigmentation )
9.Family History
• consanguinity
• Previous siblings with neonatal jaundice
• Other family members with jaundice
• Anemia or blood disorders
• Splenectomy
• Bile stones or gallbladder removal
10.Ask the relative if he has any question or information.
11.thanks
Neonatal seizure history taking checklist
3. Open question about the chief Complaint (Seizure)
4 . ask witness about event: Onset /Frequency /Types / Character /time / duration
5. Prenatal history :
 prenatal care, and use of medications/drugs
 Family history of neonatal seizures
 The presence of kittens at home
 Maternal illnesses or infections (Toxoplasmosis, Rubella, Cytomegalovirus, Herpes)
 Maternal diabetes, hyperthyroidism, or hypoparathyroidism
 immunization against rubella
 maternal blood groups
6.Natal history :
 Type and duration of delivery
 presence of fetal monitoring
 head trauma
 need for resuscitation
 Apgar scores, venous or arterial blood gas determinations
7.Postnatal history :
 Preterm ,small for gestational age or post maturity
 Birth weight, estimated gestational age at birth (including method of determination)
 vital signs including body temperature
 admission to NICU ,need for oxygen ,ventilator, iv AB
8.Age of onset and Type of seizure
 Multifocal ,clonic ,Tonic ,Myoclonic ,Subtle seizures
 At birth :Maternal anesthetic agents:
 Day 1 : Metabolic abnormalities such as hypoglycemia, hypocalcemia, HIE
 Days 2-3 : Drug withdrawal or meningitis.
 Day 5 or greater :Hypocalcemia, TORCH infections (toxoplasmosis, other, rubella, CMV, and HSV), or developmental
defects.
 More than 1-2 weeks. Methadone withdrawal.
9. Associated symptoms
 fever
 hypoglycemia,hypocalcemia
 skin rash,cataract ,glaucoma, ,juandice
 macrocephaly ,cephalohematoma
10.investigation
 Metabolic and septic screen, blood group and RH factor ,biluribine ,Torch screen, EEG,brain CT ,cranial sonography
11.Treatment
 improving or getting worse ,use anticonvulsant ,etc..
12 .Ask relative if he has Any question
13. thanks
Cardiac history taking checklist
4. HOPI:
If the child is cyanotic Ask about (onset, course and duration ,cyanotic spells, or squatting in older infants.)
Ask about Murmur the initial detection (first 6 hours after birth inTR,MR) (after 24 hours in ASD, VSD, PDA, PS, TOF).
Ask about Syncopal attack : right or left obstructive heart diseases , pulmonary hypertension , arrhythmia (such as prolonged QT).
Ask about palpitations: sinus tachycardia , supraventricular tachycardia , ventricular tachycardia
Ask about related symptoms to low cardiac output: (Dizziness ,blurring of vision ,oliguria ,easy fatigability ,cold extremities)
Ask about signs of Heart Failure:(RHF –H.splenomegaly,Edema,Ascites,P.effusion)(LVH –Tachypnea,R.distress ,Wheezing ,rale P .edema)
Ask about chest pain : (left ventricular outflow obstruction, aortic dissection, pericarditis, myocarditis, and arrhythmias)
Ask about exercise tolerance : (obstructive lesions such as aortic or pulmonic stenosis)
• the use of medications(warfarin, phenytoin, valoprat, vit .A , lithium, NSAIDs)
• gestational diabetes mellitus ,PKU .
• maternal SLE, and exposure to infectious (ie. Rubella, Coxsackie virus (
• prenatal ultrasounds which identify structural heart disease before birth
• cyanosis at birth
• gestational age and APGAR score ,asphyxia, hypertension, pneumonia
• birth defects (ie. heart-related or not) diagnosed at birth
• dysmorphic baby (Down ,Edwards' ,Patau ,Turner , Di George Williams and Noonan syndrome)
6.past history
• CHD ,murmur ,exercise tolerance ,chest pain ,syncope ,palpitations ,recurrent chest infection DOB, stridor, wheezing
• Admission ,blood transfusion, operation
7. Family History:
• congenital or childhood heart disease
• sudden death
8.Developmental history
• height and weight gain can be affected by poor cardiac function, pulmonary edema, or a left-to-right shunt .
9. nutritional history (feeding intolerance ,choking , sweeting)
10 Ask relative if he has Any question
11.thanks
12.Presentation
 DDx initially then most likely Dx .
 Management plane. Investigation/ Medical and Surgical management/ MDT/ Refer/Advice and reassurance/ education / F.up
Syncope history taking checklist
1.Initial approach to the patient (Introduce him/herself, explain what he/she will be doing)
2.Refer to the child by name
3.Open question about the chief complaint or the reason for the admission
4.HOPI
Before attack
 position :occur during physical activity (cardiac etiology) during long periods of standing (vasovagal)
 Aggrevated factors:
 hot weather, anexity, surprise(vasovagal)overcrowding (hysteria) trauma and fright,crying (BHS)
 Position change ,Head turning ,Coughing ,Urination ,Standing suddenly after eating
 Any warning: aura ( Seizures) , spots before the eyes, dizziness, visual field defects ( migraine) etc?
During attack (any witnesses)
 Onset of syncope /LOC(sudden in seizure) (gradual in syncope)
 Duration of LOC (prolonged in seizure) (short in syncope)
 episode Symptoms of dizziness, visual changes, nausea (vasovagal) Abnormal movements (seizure, BHS)
 Did they injure themselves? Bite tongue? (seizure)
 Incontinence (faecal or urinary)? (seizure)
 Colour of patient/ cyanosis in (cyanotic BHS)/ pale and diaphoretic in (Pallid BHS,BPV)
Post attack (any witnesses)
 postictal phase confused or sleepy in (seizure) , tired in (syncope).
 can they remember? (syncope)
 Is it recurrent?(seizure ,cardiogenic)
5.Associated symptom (palpitation,chest pain ,SOB ,Loss of hearing or tinnitus , Double vision )
6.Systematic review
7.Past history of
• CHD/RHD/arrhythmeasis,HTN ,DM
• epilepsy /head injury
• Drugs and medication (prokinetic ,erythromycin ,ASA ,Antihypertensives ,Diuretics ,Dilantin)
• Metabolic diseases (Hypo C, Hypo k ,hypo Mg).
• Migraine, headaches
• Anemia
• Meniere dz ,Neurologic dz ,Ear dz
8.Family History of :
• Similar illness /deafness (prolonged QT -Jervell Lange nielsen (AR) lethal + VT + VF)
• Sudden death, SIDS, CHD, arrhythmias, CMP
• Seizures
9.Social History of :
• Drug Ingestion
• Illicit drug use
10.At the end to ask if there is any more questions
11.Thanks
12.Presentation
 DDx initially then most likely Dx
 Management plane ,Investigation/Medical management/Advice, reassurance/education/ F.up
Palpitations history taking checklist
1. Initial approach to the patient (Introduce him/herself, explain what he/she will be doing)
2.Refer to the child by name
3.Open question about the chief complaint
4.HOPI
 Onset Do the palpitations start suddenly?
 How long do they last?
 What do you think brings them on?
 Aggrevated factors stress, worry, or excitement tea, coffee ?
 Is it recurrent?
5.Associated symptom ( dizzy or faint , chest pain ,SOB ,headache ,sweeting, Loss weight,abdominal distintion)
6.Systematic review
7.Past history of
• CHD /RHD /previous admission /surgery
• Psychologic stress
• Drugs and medication (digoxin)
8.Family History of :
• Similar illness
• Sudden death, SIDS, CHD, arrhythmias, CMP.
9.Social History of :
• Drug Ingestion
• Illicit drug use
10.At the end to ask if there is any more questions
11.Thanks
12.Presentation
 DDx initially then most likely Dx initially
 Management plane. Investigation/ Medical and Surgical management/ MDT/ Refer Advice and reassurance/
education / F.up
Chest pain history taking checklist
3. Open question about the chief Complaint (Chest pain)
4 . For any pain. determine its:
• Site and radiation.
• Character.
• Severity (e.g. 1 to 10, sleep disturbance).
• Onset and duration.
• Aggravating and alleviating factors (exercise, cold air, feeding , movement).
• Ask about any previous episodes of chest pain.
5. Associated symptoms (nausea, vomiting, shortness of breath, dizziness, cough, palpitations, fever, anxiety )
6. Systemic review:
7. past history
(similar condition ,previous admission ,recurrent chest infection , previous trauma ,surgeries, blood transfusion , joint
problem, Drug- NSAIDs and contraceptive pill)
8. Family History: (Similar illness , coronary heart disease, myocardial infarction, rheumatic fever, stroke, hypertension,
hyperlipidaemia ,diabetes)
9 nutritional history .
10 . Socioeconomic history (Effect of the chest pain on the patient's life (Employment ,Housing,Hobbies)
12.thanks
13.Presentation
 Management plane. Investigation/ Medical and Surgical management/ Refer Advice and reassurance/ education / F.up
Respiratory history taking checklist
3. Open question about the chief Complaint and HOPI (Cough /Haemoptysis/SOB/Wheeze)
4.HOPI For each symptom describe :

• Onset
• Duration
• Course
• Severity
• Precipitating Factors
• Relieving factors
5.associated symptoms (fever, weight loss, loss of appetite, night sweating.)
6. Systemic review:
Respiratory: Cough ,wheezes, SOB (dyspnea), hemoptysis, and chest pain + SOB (pneumothorax)and nasal congestion.
CVS (feeding difficulty, Exercise intolerance, chest pain, shortness of breath, orthopnea ,L L edema ,palpitation )
GIT: diarrhea, vomiting, costipation, abdominal pain.
Renal (colour and amount of urine ,dysuria, loin pain ,urgency ,frequency, polyuria,)
CNS (LOC,convulsion ,symptoms of ICP,motor/sensory symptoms,cranial nerve involvement, abnormal body movement )
Endocrine thirst ,polyuria ,fatigue , loss of wt , poor growth
Others: arthritis, nasal polyps, infertility (in adult).
6. Past history and drugs (similar condition ,previous admission , atopy, Tuberculosis, recurrent infection ,previous
surgeries, Drug history , Allergies, inhalers, nebuliser, home oxygen)
10. nutrition history
11 . Family History: (consanguinity,Similar illness, Chronic lung diseases , asthma, hay fever , TB)
12. Social History (housing ,parents Smoking /Contact with animals/pets)
14. thanks
15.Presentation
chronic cough history taking checklist
3. Open question about the chief Complaint (Cough)

• Age of onset and duration
• Character of cough Dry or wet (bovine, whooping or barking)
• Diurnal variation (nocturnal cough in asthma, croup is worst at night)
• Seasonal variation.
5.Precipitating and Relieving factors
 cold air, exercise,allergens(dust,pollen,cow milk, ,pets) ,drugs(aspirin),infection,smoking (in asthma)
 foods (in tracheoesophageal fistula)
 lying flat (in GERD)
5.associated symptoms (fever, DOB ,wheezing ,WT loss, loss of appetite, night sweating , FTT)
6. Systemic review:
 Respiratory: sneezing ,nasal itching ,hemoptysis, chest pain ,hoarseness, sinusitis (CF)
 CVS (feeding difficulty, Exercise intolerance, chest pain, shortness of breath, cyanosis)
 GIT: diarrhea, vomiting , dysphagia, hx of chocking (foreign body)..
 skin: eczema, hay fever and allergy.
7. Past history and drugs
 perinatal history: maternal smoking (pre and postnatal) ,premature(RDS /BPD), asphyxia .
 past medical illness :recurrent viral LRTI , atopy, previous admission ,previous surgeries
 Drug history : Medications, especially ACE-inhibitor ,inhalers, nebuliser, home oxygen
8. Immunization history (TB: BCG, CF:pneumococcal & influenza vaccines, asthma: influenza vaccine)
10.nutrition history (appetite ,cow milk or food allergy )
11 .Family History: (hx of asthma, hay fever ,atopy ,CF , Chronic lung diseases ,TB ,immunodeficiency )
14. thanks
Wheezy infant history taking checklist
4. Onset of the wheezing (sudden ,gradual )

 When start
 course (persistence ,intermittent )
5.associated symptom : cough ,cold, fever, poor feeding ,wt loss
6..perinatal history
Prenatal :(mother smoking , ,HTN,DM,drugs …. (
Natal (time and mode of delivery ,need for resuscitatioin , preterm )
Post natal(admission to ICU and duration ,need for oxygen ,ventilator support ,TPN ,IVH ,ROP ,juandice ,fever,home O2 )
7. past history
• previous admission
• eczyma
• food allergy
• medication
• charge/f.up previous arrange
8 . feeding history (reflex)
9.Developmental history (detail)
12. Thanks
Breathlessness history taking checklist
3. Open question about the chief Complaint (DOB)

• Duration & onset (acute subacute or chronic).
• rest or exertion
• continuous or intermittent (asthma?)
• associated cough or wheezing
• recent history of exposure to allergens (dust, pets, etc) , foreign body or chest trauma
• cold air, exercise, allergens (dust ,pollen) infection ,smoking ,foods , lying flat
5. associated symptome: Chest pain, sputum or haemoptysis, fever , night sweats ,wt loss
6. Systemic review:
Respiratory: Cough ,wheezes, , hemoptysis, and chest pain (pneumothorax)
CVS (feeding difficulty, Exercise intolerance ,orthopnea ,L L edema ,palpitation )
GIT: diarrhea, vomiting, costipation, abdominal pain.
Renal (colour and amount of urine ,dysuria, loin pain ,urgency ,frequency, polyuria,)
CNS (LOC,convulsion , ICP,motor/sensory symptoms,cranial nerve involvement, abnormal body movement )
Endocrine thirst ,polyuria ,fatigue , loss of wt , poor growth
Others: arthritis, nasal polyps, infertility (in adult).
7. Past history and drugs (similar condition , CHD ,previous admission ,atopy ,TB, recurrent infection ,previous
cardiac or thoracic surgeries, Drug history , Allergies, inhalers, nebuliser, home oxygen)
8.perinatal history (if neonate ask if premature (RDS /BPD), asphyxia at birth, recurrent cough)
9. Immunization history (TB: BCG, CF:pneumococcal & influenza vaccines , asthma influenza vaccine)
12 . Family History: (hx of CF , Chronic lung diseases , asthma, hay fever, TB , allergy , atopy, immunodeficiency )
15. thanks
16.Presentation
Bronchial asthma history taking checklist
3. Open question about the chief Complaint (Cough ,DOB ,wheezing)

• Age of Dx
• How frequent are the symptoms? (per day / night /week /month)
• How much school has been missed due to asthma?
• Are sport and general activities affected by the asthma?
• How often is sleep disturbed by asthma?
• How severe are the interval symptoms between exacerbations?
5.associated symptoms (eczyma, food allergy ,sneezing ,nasal itching , hoarseness , FTT ,diarrhea)
6.Medication and investigation
• Type ,dose , frequency ,technique of current medication
• What inhaler devices have been used?
• Diary of PEFR (best measurement)
• If skin prick test was done
• Number of GP, ER or hospital visit, admission , oral rescu steroid use ,PICU (IV steroid /Ventolin).
• Number of previous inhaler (SABA, steroid) and oral steroid used in last yr
• What previous treatments have been tried and have failed?
• are home nehulizers used for difficult asthma'?
• cold air, exercise,
• allergens (dust ,pollen,cow milk, animal,pets)
• drugs(aspirin)
• infection
• smoking
8.Measures taken to reduce exposure to house dust
• Synthetic bedclothes and pillows
• Hypoallergenic' cover for the rna ttressI pillowI d uvet
• Nylon carpet in the child's bedroom
 Frequent vacuum cleaning of the bedroom/damp dusting.
9. Past history and drugs
• perinatal history: maternal smoking (pre and postnatal) ,premature, brest or bottle milk
• past medical illness :recurrent viral LRTI , previous admission ,previous surgeries,
• Drug history : asprin ,beta blocker
10. Immunization history (BCG, pneumococcal & influenza vaccines)
11 .Family History: (hx of asthma, hay fever ,atopy ,CF , Chronic lung diseases ,TB ,, immunodeficiency )
14. thanks
CF history taking checklist
3. Open question about the chief Complaint and HOPI (CF /lung/GIT/nutrition)
4.associated symptoms fever , poor appetite
5 . HOPI. determine its:
• When start / age of onset
• Frequency of chest infections requiring oral/ intravenous antibiotics
• Amount of sputum produced
• Persistent abnormalities of bowel habit or stools despite treatment
• Recurrent episodes of abdominal pain due to meconium ileus equivalent
• (now called distal intestinal obstruction syndrome).
• Amount of school missed
• Exercise tolerance
• Result of last PFT and growth chart
• Result of last sputum sample with colonization or AB resistance
6. Systemic review:
 Respiratory: Cough ,wheezes,hemoptysis and chest pain+ SOB
 GIT: diarrhea, vomiting, costipation, abdominal pain.
 Endocrine thirst ,polyuria ,fatigue , loss of wt , poor growth
 Others: arthritis, nasal polyps, infertility (in adult).
7. Initial diagnosis
 how diagnosed, genetic analysis, sweet test
 Education given
8.Complication history
• GlT/endocrine: coeliac disease and Crohn's disease Growth failure and delayed puberty,DM, Liver
cirrhosis intestinal obstruction, rectal prolapsed.
• Respiratory: Pneumothorax,Chronic sinusitis,B.asthma Allergic BP aspergillosis,haernoptysis.
9. Past management history and drugs compliance
 disease progression in the first years of life (FTT, meconium ileus, rectal prolapsed)
 Ask about any previous episodes , hospitalisations /year, elective or emergency(including PICU(
 pancreatic supplements, diabetic progression
 Changes of management
 Complications of treatment (constipation/central line)
 dietary asupplements, dietician involvement
11.Current treatment
 current antibiotic regimens, DNase, treatment of coexisting asthma, physiotherapy
 dietary , pancreatic supplements and dietary adaptations (is there a dietician involved?)
12. Social situation and family support
13.Immunisations (influenza, pneumococcal, also pertussis and measles - easily forgotten!)
15. thanks
Stridor history taking checklist

4.HOPI symptom describe

•Age of onset
•Severity and time course
•Progression of symptoms
•Recent upper respiratory tract infection suggests croup or bacterial tracheitis

•Worsening at night suggests croup
•Worsening with feeding suggests tracheoesophageal fistula, tracheomalacia, or a neurologic disorder
•Worsening with straining or crying suggests laryngomalacia or subglottic hemangioma
•Worsening in the supine position suggests laryngomalacia, tracheomalacia, or spasmodic cough
6.associated symptom : cough , Weak or muffled cry, fever, Hoarseness, Drooling ,Dysphagia, Snoring
7. Past medical history, especially:

• Prematurity
• Complicated delivery
• Perinatal asphyxia
• Infection
• Intubation and mechanical ventilation
• Cardiac disease
• Previous admission due to respiratory diseases
• Atopy
8. Surgical history, especially:

• Neck surgery
• Cardiac surgery
• Patent ductus arteriosus (PDA( ligation
9 . family history : Down syndrome , Hypothyroidism

10.social history : Exposure to food or environmental allergens ,Psychosocial stressors
12. Thanks
Gastrointestinal history taking checklist
Vomiting history taking checklist
3. Open question about the chief Complaint (Vomiting) then ask about its charastristic
• Onset and Duration: when was your vomiting started? Acute or chronic
• Time : early morning , daytime ,nigh.
• Course: Is it for solid or liquid food
• Volume: dribble onto clothes or full stomach
• Presence of blood or bile in vomit
• Nature: effortless, forceful (onto child or parent), projectile (several feet away)
• Relation to feed and posture
• Is there nausea or not
4. Associated symptoms (fever ,diarrhea , constipation , dyspepsia , abdominal pain , abdominal distention , jaundice,FTT)
5. Systemic review:
 CNS (Mental status ,symptoms of increased ICP , headache, irritability) .
 Renal (colour and amount of urine ,dysuria, loin pain ,urgency ,frequency)
 Heamatological (bleeding tendency, bony ache ,joint pain and swelling ,skin rash )
 Respiratory (URTI , ear pain, Sinusitis )
 endocrine:( DM , tremor, flushing, sweating, neck swelling )
 metabolic (IBEM appear early in the newborn period with vomiting and failure to thrive).
6. past history
Antinatal history: (APGAR score ,meconium passage ,neonatal screening , haemorrhage or birth injury, congenital
abnormalities , number of days in hospital, NICU admission, birth and discharge weight)
Past illness : (similar condition , head trauma , previous surgeries - CNS/GIT)
7 . drug history (digoxin , opiates ,theophylline, chemoRx)
8. Immunization history(Rota vaccine)
• physical growth (height/weight growth charts – is or has the child been failing to thrive(?
• time of milestones (motor /CP) , toilet trained
• dentition (age of first teeth, loss/eruption of teeth)
• development of secondary sexual characteristics
10. Family History: (consanguinity/metabolic, Similar illness/migraine )
11 . nutritional history
-if it is infant: breastfed or bottle fed, type of formula used, how many meals, quantity of milk, how she prepare the
formula, weaning (when, what type of food she introduced) (feeding problem/cow milk allergy)
-if table food: quantity of food, quality, does the child feed himself, food refusal, drink (juice, soda, water, milk intake),
(food allergy and pica hx)
12. Socioeconomic history (income,housing ,education of family )
14.thanks
15.Presentation
Chronic diarrhea history taking checklist ( Definition: > 2 weeks)
3. Open question about the chief Complaint (Diarrhea) and its characteristic
• age of onset
• mode of onset (acute, chronic/ recurrent)
• frequency
• appearance (blood, mucous, sticky, floating)
• consistency (formed, loose, watery) /over flow infant diaper
• amount (large, small)
• smell (foul)
• tenesmus (young crying with defection)
• relation to food
5. Associated symptoms (fever ,nausea, vomiting, loss of appetite, decreased activity, irritability, weight loss
abdominal distention, abdominal pain , pallor, jaundice, constipation, sweating ,)
6. Systemic review:
 CNS (LOC,convulsion ,symptoms of increased ICP,motor or sensory symptoms,cranial nerve involvement )
 Heamatological (bleeding tendency,bony ache ,joint pain and swelling ,skin rash )
 Respiratory (URTI ,cough , Presence of blood in sputum, wheeze, noisy breathing )
7. past history
• Post natal (delayed in passing of meconium ,delay umbilical separation, prolonged juandice)
• similar condition , recurrent infection (chest) , previous admission ,GIT/ liver surgeries.
• joint problem, skin lesion/rash.
• history of travel or contact (day care)
• drugs history(laxative, antibiotic(clindamycin, cephalosporins and amoxicillin),Mg containing antacid ,chemoRx)
9. Immunization history (Rota vaccine)
10.growth and developmental history
• Normal weight gain in IBS ,dietary indigestion ,parasitic infestation ,carbohydrate intolerance .
• weight loss in immune deficiency /cystic fibrosis /post abdominal surgery / IBD and celiac disease
11. Family History: (consanguinity, Similar illness , Chronic disease Particularly of neoplastic ,IBD or coeliac disease).
12 nutritional history
• breastfed (lactose intolerance, glucose-galactose malabsorption, chloride diarrhea, cystic fibrosis)
• bottle fed (cow's milk protein intolerance or lactase deficiency).
• weaning (when, what type of food she introduced) (celiac disease ,disaccharidase/Fructose intolerance)
• If table food: (quantity of food, quality) (food allergy , celiac disease ,IBD ,malabsorption )
13. Socioeconomic history (housing ,water supply, animal )
16. Ask the relative or patient if he has any question or information
17.thanks
18.Presentation
Constipation history taking checklist
3. Open question about the chief Complaint (Constipation) and its characteristic
• age of onset
• stool frequency
• appearance
• consistency
• associated pain .
5. Associated symptoms (Fecal incontinence, vomiting, diarrhea ,loss of appetite, decreased activity, irritability, weight loss
abdominal distention, abdominal pain , pallor, jaundice, sweating ,fever )
6. Systemic review:
 CNS (hypotonia ,convulsion ,symptoms of increased ICP ,cranial nerve involvement )
 Respiratory (recurrent cough , Presence of blood in sputum, wheeze)
 Renal (urinary incontinence, amount of urine ,dysuria,urgency ,frequency)
 Endocrine:( short stature ,Polyuria and polydipsia, Delayed growth)
 Skin and joint (talpus deformities ,bony ache ,joint pain and swelling ,skin rash )
7. past history
• Post natal (delayed in passing of meconium, cong. malformation ,neonatal screen for TFT )
• similar condition , previous admission ,GIT/ liver surgeries/ VP shunt.
• drugs history (Anticholinergic ,Narcotics ,Antidepressants ,vincristine ,Pancreatic enzymes Lead ,Vitamin D)
• milestone
• motor and toilet training / urinary incontinence /bladder disease
11. Family History: (Similar illness ).
• processed foods and lack of fiber
14.thanks
15.Presentation
Faecal Soiling history taking checklist
3. Open question about the chief Complaint (Constipation) and its characteristic
• age of onset
• Assoc. constipation/withholding/absence of warning
• Parent‟s management style
•
4. Associated symptoms (urinary incontinence, irritability, weight loss ,abdominal distention, abdominal pain , jaundice)
5. Systemic review:
 CNS (LOC, convulsion ,symptoms of increased ICP,motor or sensory symptoms)
 Renal (urinary incontinence, amount of urine ,dysuria, urgency ,frequency)
 joints (talpus deformities)
 CVS (murmur, Exercise intolerance ,shortness of breath)
 Endocrine:( short stature ,coarse face )
6. past history
• Post natal (delayed in passing of meconium, cong. malformation ,neonatal screen for TFT )
• previous admission ,GIT/ liver surgeries/ VP shunt.
• drugs history (Anticholinergic ,Narcotics ,Antidepressants ,vincristine ,Pancreatic enzymes Lead ,Vitamin D)
• milestone
• motor and toilet training / urinary incontinence /bladder disease

• processed foods and lack of fiber
11.thanks
12.Presentation
Jaundice history taking checklist
(Greeting ,Introduce yourself, explain what he/she will be doing)
3. Open question about the chief Complaint (yellowish discolouration of skin,sclera ,or mucus membrane )
4. Onset of the Jaundice (sudden ,gradual )
• Duration (acute (1 week), chronic (3 weeks),
• course (progressive,regressive, intermittent )
• sit of Jaundice ( skin, sclera , mucus membrane )
• urine and stool color (dark, tea coloured urine or acholic (pale) stools)
6. Systemic symptoms (fever ,vomiting, diarrhea or constipation, abd pain, distention, Pruritus, pale stool,FTT)
7. Systemic review:
 CNS (irritable convulsion ,symptoms of ICP,motor or sensory symptoms,cranial nerve involvement )
 Renal (colour , amount of urine, polyurea )
 Ortho (bony ache ,joint pain and swelling )
 CVS (Exercise intolerance, chest pain, shortness of breath, palpitation, L L .odema )
 Respiratory system (cough, choking, wheeze, noisy breathing ,sleep apnea , previous use of puffers)
 Endocrine (abdominal mass, neck swelling, night sweat)
 Skin (itching , skin rash or pigmentation )
8. past history (similar condition ,previous admission , frequent blood transfusion ,drug history ,IV drug abuse ,
surgery , high risk sexual activities )
9.Family History(consanguinity, Similar illness ,Chronic diseases , hemolytic disease, hypothyroid, liver disease)
10. Immunization history (HBV)
11.Developmental history (behavioral change and school performance/ Wilson)
12 . Nutritional history: (appetite, carotene intake, fava bean ingestion if G6PD suspected)
13. Socioeconomic history(daycare,family member,water supply,hygienic condition ,cases of hepatitis A contact).
14.travel /contact history.
16.thanks
17.Presentation
Recurrent abdominal Pain history taking checklist
3. Open question about the chief Complaint (Abdominal Pain) and its characteristic
• Time /when start and trigger factor
• Place/Location: identify the specific location of the pain
• Quality: can be a sharp stabbing pain(i.e. trauma) or diffuse, poorly,localized pain (i.e.chronic or visceral(
• Radiation: pain can radiate from its point of origin in any direction
• Severity: degree of pain on a scale of 10 /wake up at night
• duration of pain, frequency ,course during the day, does it wake them at night
• Alleviating Factors: anything that reduces the pain – body position, movements , Purging ,medications.
• Aggravating Factors: anything that increases the pain – body position,movements, relation to food intake.
• Attempted interventions or therapies
4.Appetite , satiety and bowel movement patterns and stool quality (size, hard/soft, odour)
5. Associated symptoms (fever,nausea,vomiting, refex ,hematemesis, melena,weight loss, Jaundice )
6. Systemic review:
 CNS : Diaphoresis ,Dizziness headache
 Renal (Testicular pain ,Dysuria/polyuria/hematuria ,Vaginal/Penile discharge ,Dysmenorrhea (
 joint pain and swelling (IBD HSP)
 Respiratory (recurrent URTI ) (CF)
 Endocine Delayed growth and pubertal development(CF) (IBD)
 Skin Lesions (IBD HSP Liver disease)
 Eye:( redness, blurred vision)
7. Effect of symptoms on activities, school, play, and relationships
8. past history
• Cystic fibrosis / gallstones, Spina bifida, cerebral palsy, developmental delay/ constipation.
• Sickle cell disease ,Recurrent respiratory tract infections suggest mesenteric adenitis .
• sexual history – Females: menstrual cycles (regularity, amount of bleeding,relation to abdominal pain)
• Drugs history(NSAIDs) , food allergy and Past surgical history
• Normal weight gain in IBS ,dietary indigestion ,parasitic infestation ,carbohydrate intolerance .
• weight loss in immune deficiency /cystic fibrosis /post abdominal surgery / IBD and celiac disease
10. Family History: (migraine , IBS,IBD, peptic disease,pancreatitis, biliary disease).
• in young children, too much milk can lead to constipation.
12. Socioeconomic history (school, play, ,housing ,water supply, social and psychiatric (potential stressors) history)
14.thanks
15.Presentation
 Brief introduction (personal data and current state /+ve main problem /organic causes wt loss(
 Management plane. Investigation/ Medical and Surgical management/ MDT/ Refer Advice and reassurance/ education
/ F.up
Upper gastrointestinal Bleeding history taking checklist

3. Open question about the chief Complaint (Bleeding)
4 : onset & duration. course , rate (brisk or gradual )
 Type: 1- Hematemesis (emesis of fresh or old blood)
2- Hematochezia (passage of fresh or dark blood from the rectum)
3- Melena (shiny, jet black, tarry stool)
 color (fresh or dark in vomiting, bright red, dark maroon, tarry black in stool ).
 forceful vomiting.
 painful or painless.
5. Associated symptoms (nausea, vomiting, dysphagia, loss of appetite, decreased activity, irritability, weight
loss,abdominal distention, abdominal pain , pallor, jaundice, constipation, sweating ,fever, growth )
6. Systemic review:
7. past history (similar condition ,previous admition ,recurrent infection , previous surgeries, bleeding tendency, blood
transfusion , skin lesion/rash. infectious contacts ,allergy to cow or soy milk and drugs history (NSAIDs) )
8.perinatal history
 Prenatal ,Natal ,Post natal(delayed in passing of meconium)
11. Family History: (consanguinity, Similar illness , Chronic disese History family x of liver disease or peptic ulcer disease or
duodenal ulcer, coagulopathy)
12 .nutritional history (red foods, red drink)

14.travel history.
16.thanks
17.Presentation
Lower gastrointestinal Bleeding history taking checklist

3. Open question about the chief Complaint (Bleeding)
4 : onset & duration.

 color: bright red, dark maroon, tarry black
 rate & frequency: on& off, continuous.
 type: blood streaked, mixed.(Hematochezia / Melena)
 painful or painless.
5. Associated symptoms (fever , pallor, jaundice, mouth ulcer, nausea, vomiting, weight loss, loss of appetite, decreased
activity, irritability,abdominal distention, abdominal pain , constipation)
6. Systemic review:
 Renal (colour and amount of urine , urgency ,frequency nephrolithisis -IBD)
 CVS (shortness of breath, orthopnea ,L L edema ,palpitation )
 joint pain and swelling: HSP, IBD.
 skin changes: (purpura: HSP, coagulopthy) (erythema nodosum: IBD)
 eye sx: (episcleritis, uveitis, iritis =IBD)
7. past history (similar condition , previous GI surgeries, bleeding tendency, blood transfusion , skin lesion/rash,allergy to
cow or soy milk and drugs history (NSAIDs) )
11. Family History: (consanguinity, Similar illness , Chronic disese History family x of liver disease or peptic ulcer disease or
duodenal ulcer, coagulopathy ,IBD)
12 nutritional history (red foods, red drink)

14.travel history/ infectious contacts...
16.thanks
17.Presentation
Failure to thrive history taking checklist
1.Initial approach to the patient (Greeting ,Introduce yourself, explain what he/she will be doing)
3. Open question about the chief Complaint (Failure to thrive )
 when did it start? & length affected?
4. Detailed dietary history
Breastfeeding and/or formula history ?
 Any problems?
 How do you know when the infant has had enough?
 Breastfeeding technique?
 Type of formula? How is it prepared? How much per day?
 Is the baby held when fed? Eye contact? Enjoyable experience?
 Issues with vomiting? Spitting up? Reflux?
 Is there any sweating with feeds?
solids
 Have solids been introduced? If so when?
 What foods/drink does the diet consist of?
 How much does the infant/child eat? Snacking?
 How often is the infant/child fed? Where does eating take place? At table or in front of television?
5. Systemic review:
 Feeding difficulties- Appetite? Behavioural? Structural? Swallowing mechanism?
 Does the infant/child appear to have difficulty swallowing? Any anatomic abnormalities?
 Change in infant/child’s behavior Fatigue? Decreased energy (not as active as usual)?
 Vomiting/spitting up?
 Stool function? Frequency, color, consistency?
 Food likes ,dislikes, allergies .
 Frequent illnesses?
 Symptoms of heart/respiratory disease?
6. past history
Prenatal Hx:
 Health concerns during the pregnancy?
 Any exposures? (smoke, alcohol, other drugs)
 Complications with delivery?
Past medical Hx :
 chronic medical illness (frequent infections ,asthma, allergy ,anemia, congenital heart disease).
 regular drug use.
• hx of trauma, hospitalization ,surgical illnesses.
low compared to other infants/kids? Speech? Gross Motor function? (Rolling over, crawling, walking), fine motor function?
8.Family History (medical conditions or FTT in siblings, family members with short stature, mental illness in caregiver.)
9. Socioeconomic history
 parents (job, married or divorced), income, insurance, who feeds the child, life stressors (loss of job, divorce, death)
availability of social and economic support, perception of growth failure as a problem
 Hx of abuse or violence of the caregiver
 Hx of parental depression, unusual dietary beliefs, lack of knowledge and parental relationship to the child (how
much time they spend together)
10.travel history.
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Obesity history taking checklist
3. Feeding history in detail
• What does he/she eat in a typical day? Per meal?
• how much of their meal is (carbohydrates/fats/protein/dairy)
• Snacks outside of mealtimes?
• Frequency of fast food?
• How often does the family eat dinner together? Where at the table or in front of the TV?
4. exercise history
• How many minutes/ hours of physical activity does he/she participate in during a typical day? At school? After
school? Weekends?
• How many combined minutes/ hours in a typical day does he/she watch TV, use the computer, or do a sedentary
activity? Afterschool? Weekends?
• How does weight affect the child’s daily function? Is he/ she being bullied ?
5. Psychological history
• Ask about any history of psychological problems such as eating disorders, eating to cope with problems,depression.
• How does he/she feel about how he/she looks?
6.Ask parent
• Can the parent offer some ideas as to what can be affecting the child’s weight?
• How long has this been going on for ?
 How does weight affect the child’s daily function? Is he/ she being bullied?
6. past history
• Does he/she have any diagnosed medical conditions?
• Is he/she on any medications?
• Has he/she tried any diets/ regimens to try to lose weight?
•
8. Family History:
 Does he/she have any family members with weight problems?
 Does he/she and the family feel ready to make lifestyle changes?
• Are there any growth (weight gain) and developmental concerns
10. vaccination history

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Eating disorders history taking checklist

4.Asks about
• current weight and height /Determines amount and time course of weight loss
• Asks whether weight loss has been intentional
• Asks whether patient still considers herself to be overweight
• Asks how often patient weighs herself/looks at herself in mirror
• Assesses patient’s degree of insight into eating disorder
5.
• Establishes amount and type of food eaten on a typical day
• Asks about binge eating
• Asks about vomiting
6.Drugs
• Asks about laxatives, purgatives, and diuretics
• Asks about appetite suppressants and stimulant drugs
7.Asks about physical exercise
8.Asks about menstrual periods
9.Asks about common medical complications of eating disorders
10.Asks about common psychiatric complications of eating disorders
11.Asks about effect of eating disorder on patient’s life
12. Family History: (Similar illness , eating disorder,mental illness)
13. Socioeconomic history (income ,education of family )

14.Ask the patient if she has any question or information.
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16.further suggestion
• Suggests taking an informant history from patient’s mother
• Suggests physical examination
• Suggests laboratory investigations
• Suggests giving dietary advice
• Suggests referral to eating disorders team for further management
Abdominal mass history taking checklist
3. Open question about the chief Complaint (Abdominal mass) and its characteristic
• age of onset
• mode of onset
• site
• Stooling pattern (frequency and consistency)
• Voiding pattern (frequency and hematuria)
4. Associated symptoms (fever , vomiting , constipation, irritability, weight loss, jaundice)
5. Systemic review:
 CNS (convulsion ,symptoms of increased ICP,motor or sensory symptoms,cranial nerve involvement )
 Renal (H.uria , amount of urine ,dysuria,urgency ,frequency)
6. past history
• In neonates: maternal pregnancy oligohydramnios/polyhydramnios, or any interventions (such as amniocentesis)
• History of trauma
• Menstrual history
• History of abdominal surgery or umbilical catheterization
• motor and toilet training / urinary incontinence/ soiling /bladder disease


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12.Presentation
Hepatomegaly history taking checklist
3. Open question about the chief Complaint and HOPI (Hepatomegaly)
• onset and duration
• history of recent infection? (eg: rash, pharyngitis, cough, SOB, fever, exposure, poor feeding, malaise etc)
• consumed any contaminated food or experienced any diarrhea and/or vomiting?
• any change in stool /urine color? What color are his/her stools/urine?
• history of loss of consciousness or seizures?
4. Associated symptoms (fever , jaundice, vomiting , diarrhea, abd ,pain, weight loss)
5. Systemic review:
 CNS (LOC, convulsion ,symptoms of increased ICP,motor or sensory symptoms,cranial nerve involvement )
 Renal (H.uria , amount of urine )
 CVS (feeding difficulty, Exercise intolerance, shortness of breath, orthopnea , L L edema )
 Respiratory (URTI ,cough , wheeze, noisy breathing )
6. past history
• complications during pregnancy, delivery, and after delivery?
• Is there any maternal history of hepatitis B or C, CMV, EBV or HIV?
• Does the child have any preexisting liver diseases, lung diseases, or congenital heart diseases?
• Is there any history of drug or toxin ingestion? Is there any exposure to radiation?
• Is the child on any medications right now?
• Is there any history of trauma?
8. Family History: (family history of cystic fibrosis, alpha-1 antitrypsin deficiency, storage diseases, liver diseases, heart
diseases, autoimmune diseases or malignancy?).
9. recent travel/contact
10. vaccination history (HBV)
11. nutritional history

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14.Presentation
Splenomegaly history taking checklist
3. Open question about the chief Complaint and HOPI (Splenomegaly)
• onset and duration
• history of recent infection? (eg: rash, pharyngitis, cough, SOB, fever, exposure, poor feeding, malaise etc)
• • Is there any abnormal bruising, bone pain, or history of frequent infections? .
4. Associated symptoms (fever , jaundice, night sweats, or weight loss)
5. Systemic review:
 CNS (LOC, convulsion ,symptoms of increased ICP,motor or sensory symptoms,cranial nerve involvement )
 Renal (H.uria , amount of urine )
 CVS (feeding difficulty, Exercise intolerance, shortness of breath, orthopnea , L L edema )
 Respiratory (URTI ,cough , wheeze, noisy breathing )
6. past history
• complications during pregnancy, delivery, and after delivery?
• Was there persistent, unresolved jaundice following delivery?
• Does the child have any congenital heart diseases, storage diseases, bleeding disorders or liver diseases?
• Does the child have any history of surgeries or transfusions?
• Is there any history of trauma?
8. Family History:
 Is there any family history of hematological diseases, autoimmune diseases, storage diseases, or malignancy
 What is the family ethnicity
9. recent travel/contact
10. vaccination history
11. nutritional history

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14.Presentation
Nephro/Urological history taking checklist
4.HOPI : Asks specifically about:
• Pain /frequency /urgency /dysuria /haematuria /odema //dribbling /poor stream/urine retention
• urethral discharge /testicular masses or testicular pain /undescending testes
• sexual dysfunction /sexual contacts
5.Timing of the problem :
• onset, frequency, time of day, and duration. Is it ongoing? Has it happened before? If so, characterize.
6. Associated symptoms (fever, vomting ,Weight loss, fatigue , jaundice)
7. Systemic review:
 Skin: rashes
 Eyes: vision , glasses.
 Cardiorespiratory: exercise tolerance ,dyspnea .
 Respiratory : coughing, hemoptysis.
 Hematology: bleeding tendency ,sickle cell anemia. hb urea: intravascular hemolysis = G6PD & PNH.
 Gastrointestinal: vomiting, abdominal pain, diarrhea, constipation
 Neuromuscular: headache , seizures, problems with movement (eg. ataxia), muscle/joint pain.
 Endocrine: abnormalities of genitalia, precocious puberty ,FTT, growth disturbances.
8. past history
• kidney diseases ,recurrent UTI /renal stones, urine retention.
• past hospitalizations/ operations (age, indication)
• drugs and allergies
9 . perinatal history (1st time voiding)
• time of milestones (Motor ,hearing ,vision ,toilet trained(
• Nocturia /incontinence
• development of secondary sexual characteristics.
11. Family History:
• family history of AHT,chronic kidney diseases,renal stones,CRF,dialysis,renal transplantation, deafness
12. Socioeconomic history (water supply )
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15.Presentation
]
Enuresis History taking cheklist
3. Open question about the chief Complaint (Enuresis)
4.HOPI : Asks specifically about:

• Onset: primary vs. secondary / Nocturnal vs. daytime
• Frequency and severity (during daytime and nighttime)
• number of episodes/night
• number of nights/week
• Urination pattern - dribbling, dysuria, hesitancy, urgency, quality of stream
5. Associated symptoms (Lower back pain ,Abdominal pain , Bad dreams ,Parasomnias )
6. Systemic review:
 CNS: developmental delay ,spinal defect , LL hypotonia , Gait disturbance.,
 Endocrine: FTT, polyuria ,polydipsia
 Cardiac: exercise tolerance ,dyspnea.
 Respiratory : coughing, hemoptysis ,Nighttime snoring.
 Hematology: sickle cell anemia..
 Gastrointestinal: vomiting, abdominal pain, diarrhea, constipation ,Encopresis
 Skeletal: talpus deformity
7. past history
• Birth history, especially any complications (1st time voiding)
• urinary tract infections
• History of CNS trauma, Injury to the genital or back area
• diabetes insipidus, diabetes mellitus and CRF
• Surgical history
8. Fluid intake and dietary habits
9 . History of stressful events and other psychosocial history including abuse
10. Medications and Family’s and patient’s attitude toward the bedwetting
11.Developmental history time of milestones (Motor ,hearing ,vision ,toilet trained(
12. Family History: of enuresis
13. Medications and Family’s and patient’s attitude toward the bedwetting

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Red urine history taking checklist
3. Open question about the chief Complaint (Red urine)
urine
• color {pink to red (extra renal), brown (renal)}, smell, stones, clots (extra renal)
• At which phase of urination
• duration of the problem
• time at night or with activity
• frequent & amount in each episode of urination or not
• previous similar problem.
• Recent history of:
• ✓Recent febrile illness
• ✓Recent pharyngitis
• ✓Recent streptococcal skin infection
• ✓ Recent trauma, menstruation,or strenuous exercise
4. association symptoms (fever , dysurea, pain, edema , headache,Weight loss, fatigue, FTT, pallor, jaundice)
5. Systemic review:
 Respiratory system (URTI): IgA GN ,HUS ,post.GABS ,good pasture syndrome ,DOB, hemoptysis ,.
 CVS: Exercise intolerance, fatigue (acute secondary to HTN).
 GIT: bloody diarrhea HUS ,abdominal mass.
 CNS: headache, LOC, convulsion = hypertensive encephalopathy
 Locomotor: Arthritis = SLE.
 Skin: (rash/ HSP ) (photosensitivity / SLE), (petechial / bleeding tendency)
(skin infection /post strept(.
(Jane way & Osler nodules /infective endocarditis(
• Eyes & Ear: deafness, cataract & keratoconus = Alport syndrome
• Hematology: bleeding tendency ,sickle cell anemia. hb urea: intravascular hemolysis = G6PD & PNH.
6. past history
Medical history :kidney diseases, recurrent URTI, trauma & exercise
Drug hx & food intake:
• urate/ rifampicin/ flugy= orange urine.
• methylene blue= green urine.
• alcapronuria= black urine.
• cyclophosphamide= hemorrhagic cystitis .
• anticoagulants, chronic salcycilate, desferrioxmine.
• food
7.Developmental history (deafness /alport syndrome.)
8. . Family History (H.urea, renal diseases ,tendency to form stones, deafness /alport syndrome.)
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11.Presentation
Relapsing nephrotic syndrome history taking checklist

2.personal data (age) , Refer to the child by name

4 : Ask about general health at moment

5. Ask about time concerned this might be relapse /when stop Rx
6. other symptom apart from puffy eye (H,urea,oliguria ,shock ,headache ,abd. Pain)
7.Confirm and discussed previous Dx

• Initial time presentation, initial Dx, how, who
• This 1st time relapsing or there previous relapse
• Medication (dose/duration)
• Complication
8.Ask about pediatrican f.up notic (BP , urine for H.urea, renal failure ,maximum body wt)
9.past medical history (mainly varicella ,medication)
10. Immunization history(mainly pneumococcal ,influnza)
11. Family History: (renal diseases, SLE, Chronic renal failur)
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14.Presentation
/ F.up
Neurological history taking checklist
3. Open question about the chief CNS Complaint (Seizures, Hypotonia , Headache)
4 : onset
• course
• frequency
• Time day /night
• duration
• Character
• Loss of consciousness
• Motor or sensory symptoms
• Signs of increase ICP
• Meningeal signs
• Aggravating factors
• Relieving factors
(fever, loss of appetite, vomting , decreased activity, irritability, weight loss, sweating, sleep pattern )
6. Systemic review:
 liver
 kidney
 gastrointestinal tract
 heart and blood vessels
7. past history (similar condition , febrile convulsions , head trauma ,previous admission , previous surgeries,
bleeding tendency, joint problem, skin lesion/rash allergy and drug history)
8.perinatal history (any neonatal fits)
9. Immunization history (DPT,measels)
10.Developmental history (especially delay in first 2 years of life)
11. Family History: (consanguinity, Similar illness , developmental delay)
13. Socioeconomic history .
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16.Presentation
Seizure history taking checklist
3. Open question about the chief Complaint (Seizure)
4 . ask witness about event: Onset /Frequency /Types / Character /time / duration
5.Pre-ictal event
 provoking factors such as fever, illness, TV, stress, sleep deprivation, ingestion, compliance, trauma
6.Ictus event
 aura,duration, focal features, motor signs, Loss of consciousness, cyanosis, urination,self injury ,tounge bit
7.Postictal event
 unilateral headache, weakness, aphasia, visual field defects
8.Evolution
 improving or getting worse ,Relieving factors (anticonvulsant ,etc..)
9. Associated symptoms (Symptoms of increased ICP , Motor or sensory,CN involvement , meningeal irritation)
11.When problem start /controllable or more frequent
12. Perinatal history (any neonatal fits)
13.Past medical history
 History of febrile seizures ,head trauma, meningitis, status epilepticus,Hospital or intensive care admissions
14.Drugs history (past and present, doses, side effects, allergy)
15.Developmental history (especially delay in first 2 years of life)
16. Family History: (consanguinity, eplepsy , developmental delay)
17. Social history (behavioral, educational,school, financial problems)
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20.Presentation
 Management plane. Investigation/ Medical and Surgical management/ MDT/ Refer Advice / education / F.up
Febrile seizure history taking checklist
3. Open question about the chief Complaint (febrile Seizure)
4.Pre-ictal event
• Ask about fever (onset, grade ,duration before seizure)
• Ask if there has been any recent illness (URTI,GE,UTI)
• Ask if there has been any recent immunizations ( same day of DTP /and 8 to 14 days following MMR )
5.ask about ictal event: Was it really a seizure? If yes, what type – typical or atypical?
• Onset /time
• Types and Character generalized /focal features, , loss of consciousness, cyanosis
• duration (more or less than 15 min)
• termination Relieving factors (antipyretic , anticonvulsant ,etc..)
• Frequency /24 hrs
6.Post-ictal event (confusion/fatigue).
7. Ask about source of the fever

• symptoms suggestive of CNS infection/lesion Symptoms of ICP , meningeal irritation /Motor or sensory involvement )
• other non-febrile causes of the seizure, electrolyte abnormalities due to persistent vomiting with a current viral illness
8. Perinatal history (any neonatal fits)
9.Past medical history
 History of febrile seizures ,head trauma, meningitis, status epilepticus,Hospital or intensive care admissions
10.Drugs history (past and present)
11.Developmental history (developmental delay)
12. Family History: (consanguinity, eplepsy , developmental delay ,medication use)
13. Social history (behavioral, educational,school, financial problems)
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Headache history taking checklist
3. Open question about the chief Complaint (Headache)
4 : onset, course and Pattern
• When headaches begin? (Chronic progressive /ICP, recurrent not progressive /Migraine or acute/secondary)
• Frequency change in frequency(2-5 attacks in Migraine,> 10 episodes in tension,15/mo for 4 mon in non progressive)
• Duration of headaches (2 - 72 hours Migraine / 30 min to 7 days Tension/ > 4 hours in Chronic progressive)
• time of day/week ( awaken from sleep in ICP, Brain Tumor) (daytime in migraine)( weekdays in tension)
• Are headaches preceded by warning? -Visual and sensory disturbances
Description of Pain
• Location (Where does it start /Unilateral or bilateral/diffused/ Primarily occipital)
• Quality (Pulsatile, tight like a band around the head or sharp)
• Severity (mild ,moderate sever effect on the patient's life).
• Effects of position, Valsalva maneuver, and movement supine in increased intracranial pressure (ICP)
 Exacerbating and relieving factors (activity, caffeine, dehydration, stress, eye strain, coughing/sneezing, bright
lights, menses, hunger. Certain foods)
• Fever, chills
• FTT, wt loss (brain tumor)
• Neurological deficit
• Nausea and vomiting.
• Neck pain, stiffness CNS infection
• Ear,Eye pain ,Change in vision ,Nasal discharge or stuffy nose (refer pain)
6. Systemic review: Systamtic review
 CNS ,LOC, convulsion ,symptoms of increased ICP,motor or sensory symptoms,cranial nerve involvement
 Respiratory : URTI , Ear pain , Nasal discharge or stuffy nose
 GIT : nausea, vomiting ,abdominal pain ,constipation , diarrhea
 Endocrine :short stature, amenorrhoea , tremor, flushing, sweating, neck swelling
 Heamatological : bleeding tendency,bony ache ,joint pain and swelling ,skin rash
 Genitourinary system: colour and amount of urine ,dysuria, loin pain ,urgency ,frequency
7. past history
 Past history of headache, migraine, intracranial lesions,head trauma and Surgery ,travel sickness ,sinus dz.
 withdrawal from NSAIDs, opioids, glyceryl nitrate, and calcium channel blockers.
 Over-the-counter medication .
 Past Evaluation: Skull XR ,Brain scan ,CT scan or MRI
8. Developmental history (developmental delay)
10. Family History: (family history of migraine and travel sickness ,Aneurysm (AD PCKD) , disorders of collagen synthesis
11 nutritional history (certain food ,chocolate, caffeine and food allergy)
13 . Socioeconomic history .(Employment, Housing ,Mood , stress at home or school ,Smoking or Alcohol use).
14 Ask relative if he has Any question ,thanks
15.Presentation
Muscle weakness / Floppy infant history taking checklist
2.personal data , Refer to the child by name, Open question about the chief Complaint
4- onset:
• Age of onset
• sudden, gradual
• Distribution (generalized ,asymmetric /unilateral , proximal (SMA , MG , Myopathy ) or distal (HMSN)
• Duration
• progression
• Severity
• Continuous? Intermittent?
• Aggravating/alleviating factors
5. Associated symptoms (Dysmorphic features ,fever ,FFT , weak cry, poor sucking ,feeding difficulty,chocking, R. distress ,
muscular pain, abnormal gait, sensory affection ,muscles atrophy or hypertrophy, decreased activity, MR )
6. Systemic review:
 LOC, seizure , squint ,motor or sensory symptoms, Spinal defect ,learning difficulties, gait & posture abnormality
 Respiratory : coughing, SOB, recurrent aspiration ,O2 Rx.
 Renal (dysuria, loin pain ,urgency ,frequency)
 CVS (, Exercise intolerance, chest pain, shortness of breath, ,L L edema )
 GIT (poor feeding, nausea, vomiting ,chocking ,regurgitation ,constipation , diarrhea)
 Endocrine:(short stature , delay puberty)
8. past history
prenatal :maternal weakness ,drugs, alcohol, radiation exposure, Torch Infection, fetal movement ,oligo/ polyhydraminous
previous pregnancy loss, abortions, still birth ,neonatal death
Perinatal : -Prematurity , dysmorphic features ,Perinatal asphyxia ,RDS, intracranial hemorrhage,
Postnatal: - weak cry, small head, NICU admission ,use ventilator , Infection (Meningitis) , birth injury, jaundice and screen (TSH)
past illmess : recurrent aspiration pneumonia , previous admission ,trauma ,surgeries ,O2 support
4.Gross motor
• head control (6 weeks) ,Roll over (4 mon) ,sit (6 mon), crawl (8 mon), creep (9 mon) ,stand (10 mon) walk (12 mon)
run (16 months) ,walk upstairs and throw ball (24 months), kick ball (2 .5 yrs ) , ride tricycle (3 yrs)
7.fine motor
 Holds rattles (3 months ) (reach object and transfer and mouthing (6 mths ( ,raisins and casting (9 mths) ,Pincer (12 mths)
 build blocks (15 m) ,tower (24 m) and bridge (3yr)
 hold pen + scribble (18 mo), Verticle line (24 mo ) ,draw circular and cut paper (3 yrs)
8.Speech and languge
• What exactly he can say?
• What he can understand?
Ask if bowel control (3 yrs) and bladder control (4 yrs)
Ask if dressed and undressed (4 yrs)
Personal , social & Play
11. Family History: (consanguinity, Similar illness,neurological disease,developmental delay, epilepsy,MR early death ,genetical diseases)
12 nutritional history (feeding difficulty , recurrent aspiration FTT and poor wt gain )
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17.Presentation
Ataxia history taking checklist
3. Open question about the chief Complaint (Ataxia)
4 : Ask about
• Onset(Acute, insidious ,chronic)
• progression (congenital vs insidious vs acute)
• nature of ataxia (A midline truncal, lateral , FN lobe syndrome ,sensory ataxia)
• distribution (unilateral , truncal)
ask about
• Any previous episodes of ataxia
• any recent viral infection or cough? Varicella is the most common acute infectious cause of ataxia
• Any medications, drugs or poisons possibly ingested? Are there any visitors taking anticovulsants or antipsychotics ?
• Any alcohol or other illegal drugs?
• Any trauma?
• Is there the possibility of a suicide attempt?
5. Associated symptoms (fever, nausea, vomiting, lethargy, headache, head tilting? )
6. Systemic review:
• CNS : ICP: early morning headache, vomiting, nystagmus ,Dysarthria ,Sensory loss, change in mental status
 CVS (feeding difficulty, chest pain, shortness of breath ,L L edema ,palpitation)
 GIT (abdominal distention, pain , pallor, jaundice, constipation , diarrhea, vomiting)
7. past history
Birth Hx:
• exposures, TORCHES (congenital infections including toxoplasmosis, rubella, CMV, Herpes, Syphillis)
• congenital anomalies (ataxia can be congenital or hereditary, but not appear until later).
9. Immunization history (varicella)
10.Developmental history (developmental delay)
11. Family History:
• consanguinity,Similar illness , Chronic disese , sickle cell, metabolic disease, epilepsy, migraines or Friedrich’s ataxia(
12 nutritional history (malnutrition ,vit E deficiency)
13 . Socioeconomic history .
Abnormal Movement history taking checklist
3. Open question about the chief Complaint (abnormal Movement)
4 : onset, course ,duration ,frequency, Distribution
• Symmetry
• Speed of movement—fast (excessive movement, hyperkinetic) or slow (paucity of movement, hypokinetic( Presence at rest?
With action
• Relation to certain postures or positions
• Task specificity
• Ability to suppress
• Stereotyped ,Rhythmic
• Continuous? Intermittent? Occurring in discrete episodes
• Association with an urge
• Persistence during sleep
• Association with functional motor impairment
• Aggravating/alleviating factors
• LOC, convulsion ,symptoms of increased ICP,motor or sensory symptoms,cranial nerve involvement
5. Associated symptoms (loss of appetite, decreased activity, irritability, weight loss, sweating ,fever )
6. Systemic review:
 GIT (abdominal distention, abdominal pain , pallor, jaundice, constipation , diarrhea, nausea, vomiting)
7. past history (similar condition ,previous admition ,recurrent infection , previous surgeries, blood transfusion , joint
problem, skin lesion/rash ,allergy or drug history)
8.perinatal history
11. Family History: (consanguinity, Similar illness , Chronic disese ,history of convulsion )
12 & nutritional history
.13 . Socioeconomic history .
17- travel history
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20.Presentation
Neurodevelopment history taking checklist
1.Initial approach to the patient : Greeting ,Introduce yourself, explain what you will be doing
3.Developmental history in detail (age milestones)
• <18 months - begin questions around gross motor abilities, then vision and hearing skills, followed by hand skills.
• 18 months to 2.5 years -begin with speech and language then fine motor (hand) skills ,later questioning about gross motor
• 2.5 to 3.5 years - initial questions are best focused around speech and language and social/emotional/behavioural skills.
4.Gross motor
• Ask when has head control (6 weeks) ,Roll over (4 mon) ,sit (6 mon), crawl (8 mon), creep (9 mon) ,stand (10 mon) walk (12 mon)
• run (16 months ,walk upstairs and throw ball (24 months), kick ball (2 .5 yrs ) , ride tricycle (3 yrs)
5.Vision
• Ask about newborn screen-:If there are eye anomalies (red reflex)( cataract).
• Ask if Fix and follow human face (6wks)
• Ask if Reaches well for toys (6mon)
• Ask if can pick up raisn(9mon)
• Ask about result of screen of visual acuity and squint at school entry (4-6 yrs)
6.Hearing
• Ask about newborn hearing screen test (EOAE)
• Ask if notices sudden prolonged sounds ( 1 month )
• Ask if smiles and turn his head or eyes towards your voice even when he cannot see you (4 months)
• Ask if turns immediately to your voice across the room or to very quiet noises (7 months)
• Ask if listens to family every day sounds and searches for very quiet sounds made out of sight(9 months) .
• Ask if shows some response to his own name and to other familiar words and respond to 'no' (12 months).
7.fine motor
 Ask if Holds rattles (3 months ) (reach object and transfer and mouthing (6 mths ( ,raisins and casting (9 mths) ,Pincer (12 mths)
 Ask if can build blocks (15 m) ,tower (24 m) and bridge (3yr)
 Ask if can hold pen + scribble (18 mo), Verticle line and turn pages of book at time (24 mo ) ,draw ircular and cut paper (3 yrs)
8.Speech and languge
What exactly he can say?
• Ask if cooing (2-4mo ) ,babble (6mo) ,said dada and (10 -12 mon)
• Ask if know 4 words (18 mths) , 2 words join (2 yrs), know 50 words, said name, age and count 1 – 10 (2.5 yrs)
What he can understand?
• Ask if respond to own name and inhibit to no (10mths)
• Ask if he point own body (18 mo) ,know colour (3 yrs)
• Ask if understand complex instruction and ask how ( 4 yrs) .
• Ask if Knows if morning or afternoon ( 5 yrs)
9.Personal & social/ Play
• Ask if smile (6 weeks) ,has stranger anxiety (8 months),wave bye bye ( 12 months)
• Ask if Finger feeding (10 mo) drink from cub (18 months) eat with spone ( 2.5 yrs) use knife (5 yrs).
• Ask how play alone (2yrs) , begine to share toys (3 yrs) has friends (4 yrs)
• Ask if bowel control (3 yrs) and bladder control (4 yrs)
• Ask if dressed and undressed (4 yrs)
10 . perinatal history
• Prenatal : - previous pregnancy loss, sibilant neonatal death ,Torch Infection /Toxins (e.g. drugs,alcohol)
• Perinatal : -Prematurity /hyperbilirubinaemia /Perinatal asphyxia /hypoglycaemia /meningitis
• Postnatal: - NICU admission ,drugs (steroid/Lasix,gentamicin)Infection (Meningitis, encephalitis) /Vascular accidents birth injury and screen
11.Past history :
• head trauma, admission, surgery
• result of previous investigation (brain CT /MRI) (metabolic screen)(EEG)
• previous professional involved (pediatrician, dietician, physioRX ,speech Rx)
• medication history
• immunization
12.Family social history ( consagulity/blindness/deafness /genetical diseases/developmental delay /eplepsy/MR/death)
13.growth and feeding history
15.thanks
16.Presentation
 Now determine where specific developmental delay Global /motor /Speech or social development delay
Global development delay history taking checklist
4.Developmental history in detail (age milestones)
• gross motor
• fine motor and vision
• hearing and speech
• social and behavioural
5. Age of onset:
• First 6 months – (Tay-Sachs disease, Leigh disease, tuberose sclerosis)
• Toddlers – (infantile metachromatic leukodystrophy, mucopolysaccharidoses, infantile Gaucher, Krabbe disease (
• Older children – (juvenile Batten disease, SSPE, Wilson disease, Huntington chorea)
6. Ask about comorbidities problem
 seizure and dementia (gray matter/neurodegenerative)
 spasticity, cortical deafness and blindness (whit matter)
 Feeding ,wt gain/reflex/constipation ,aspiration ,contraction/scoliosis(CP)
 Dysmorphic features – (Down syndrome, Noonan, mucopolysaccharidoses)
 Neurocutaneous signs – (ataxia telangiectasia, Sturge-Weber syndrome, incontinentia pigmenti, tuberose sclerosis)
 Extrapyramidal movements – (cerebral palsy, Wilson disease, Huntington chorea)
 Tremor – (Wilson disease, Friedreich's ataxia, metachromatic leukodystrophy)
7.ask about general health (fever, vomting , abnormal odour)
8 . perinatal history
• Prenatal : - previous pregnancy loss, sibilant neonatal death ,Torch Infection /Toxins (e.g. drugs,alcohol)
• Perinatal :Prematurity /hyperbilirubinaemia /Perinatal asphyxia /hypoglycaemia /meningitis
• Postnatal: NICU admission ,Infection (Meningitis, encephalitis) /Vascular accidents Head injury neonatal screen
9.Past history :
• head trauma, Meningitis, encephalitis , admission, surgery
• previous professional involved (pediatrician, dietician, physioRX ,speech Rx)
• medication history
• vaccination(SSPE/measles)
10.Family history : (consagulity/affect sibilant /genetical diseases/developmental delay /eplepsy/death)
• FTT and poor wt gain (CP)
• faltering growth ( metabolic disease,
• gigantism ( Soto syndrome)
• slowing head growth
• Large head – (Alexander, Canavan, Tay-Sachs syndromes, mucopolysaccharidoses (
• Small head - (cerebral palsy, Rubinstein-Taybi, Smith-Lemli-Opitz, Cornelia de Lange syndromes)
12. social History : (housing /transport/education/social help)
14.thanks
Speech delay history taking checklist
4. Age of onset:
5.Ask if problem with language input(receptive comprehension dysphasia)
• Ask about hearing
• Ask about social history if reduced exposure to spoken language,e.g. (twins ,parenting skills ,familial pattern,education,school)
Ask if problem with language output (expressive dysphasia)
• Ask about development Motor /oromotor incoordination, e.g. cerebral palsy
• Ask if there anatomical deficit, e.g .cleft palate ,tongue tie
Ask if problem with language processing (mental, social and behavioral development)
• general developmental delay (mental retardation)
• poor social skills, i.e. autistic disorder
Ask if problem due to specific speech and language delay
• linguistic processing ( articulation stammering ,dyspraxia) (Grammar forms and structure of language)
Problems in understanding the meaning of words , sentences or social use of language
6.Developmental history in detail (age milestones) (gross ,fine motor and vision ,social and mental).
 eplepsy (Liandau-Kleffner syndrome) (gray matter)
 spasticity and cortical blindness (whit matter)
 Feeding ,wt gain/reflux/constipation ,aspiration ,contraction/scoliosis(CP)
 Dysmorphic features – (Down syndrome, mucopolysaccharidoses)
 Neurocutaneous signs – (ataxia telangiectasia, Sturge-Weber syndrome, incontinentia pigmenti, tuberose sclerosis)
 Extrapyramidal movements-athetosis – (cerebral palsy, Wilson disease, Huntington chorea)
 Tremor – (Wilson disease, Friedreich's ataxia, metachromatic leukodystrophy)
8.ask about general health (fever, vomting , abnormal odour)
9 . Past history
perinatal: -
• Torch Infection /Prematurity / asphyxia/ hypoglycaemia /meningitis
• NICU admission ,drugs (lasix, gentamicin) and neonatal screen (TFT)
Past medical history:-
• head trauma, meningitis ,admission, surgery
• previous professional involved (pediatrician, a speech and language therapist)
• medication history (Lasix, gentamicin)
10.Family history : consagulity/affect sibilant /twin/developmental delay /epilepsy /death
• FTT and poor wt gain (CP)
• faltering growth ( metabolic disease)
• gigantism ( Soto syndrome)
• Large head – (Alexander, Canavan, Tay-Sachs syndromes, mucopolysaccharidoses (
• Small head - (cerebral palsy, Rubinstein-Taybi, Smith-Lemli-Opitz, Cornelia de Lange syndromes)
12. Ask relative if he has Any question
13.thanks
14.Presentation
Cerebral palsy (motor development delay) history taking checklist
3. Open question about the chief Complaint (motor development delay)
4 .If new undignosis case (take detail history)
Prenatal(80%) : - (mainly Ataxic CP)
• Family history of consagulity/affect sibilant /Genetical diseases/eplepsy
• Infection (e.g. CMV, rubella, chorioamnionitis)
• Toxins (e.g. drugs,alcohol)
• placental insufficiency
5.Perinatal(10%) :
 Prematurity – (IVH/PVH/PVL) (mainly diplegic CP)
 Toxins e.g. (hyperbilirubinaemia -mainly dyskinetic CP )
 Perinatal asphyxia (mainly Quadriplegia CP)
 Symptomatic hypoglycaemia
 Infection (e.g. meningitis)
6 . Postnatal(10%(
• Infection (Meningitis, encephalitis)
• Vascular accidents
• Head injury (accidental or non-accidental)
• Encephalopathy
7.Ask about general health (fever ,sleep ,feeding ,bowel motion)
• feeding difficulties with slow feeding ,reflex and vomiting(quadriplegic)
• FTT and poor wt gain
• slowing head growth
 seizure
 Feeding problem ,wt gain/reflex/consipation
 aspiration
 contraction/scoilosis
 mental retardation
 Ophthalmologic/hearing impairments
 Speech and language delay
10. result of previous investigation (brain CT /MRI) (metabolic screen)(EEG)
11. previous professional involved (pediatrician, dietician, physioRX ,speech Rx)
12. medication history
13. social History:
14 Ask relative if he has Any question and thanks
15.Presentation
 Classify the type (quadriplegia, hemiplegia, diplegia, ataxic, dyskinetic).
 associated conditions
 determined the etiology of CP
Cerebral palsy(known case) history taking checklist
4 .If known case (When ,how and who Dx)
7. result of previous investigation (brain CT /MRI) (metabolic screen)(EEG)
8. Ask about major medical problem(Biggest one):(then discussed with them)

 Daily activity live
 Housing ,transport and schooling
 Mobility ,contraction, scoilosis
 seizure
 Feeding difficulty ,poor wt gain, reflex, constipation
 Aspiration and recurrent chest infection
 Communication speech ,hearing and vision impairments
9. professional involved (pediatrician, dietician, speech Rx)
10.previous contraction Rx (physioRX)
11. medication history
12.Developmental history (motor milestones ,vision,hearing)
13. family and social History: (schooling ,housing ,education and social help )
15.thanks
Locomotors history taking checklist
3. Open question about the chief Complaint (Locomotor proplem)
4.Asks about Current symptoms / complain (Pain ,Stiffness ,Swelling ) and determines its:
Pain : History points to elicit can easily be remembered using the mnemonic ‘SOCRATES’ .
 S-site/O-onset /C-character /R-radiation /A- associations /T-timing /E-exacerbating & relieving factors S severity
 ask about use of medication for pain relief.
Stiffness (early morning, night)
Swelling : site (Which joint is start involved) ( small, large or back)
Pattern of joint is involved (mono/ polyarthritis) /
 Monoarticular – only one joint affected
 Pauciarticular (or oligoarticular) – less than four joints affected
 Polyarticular – a more than four of joints affected
 Axial – the spine is predominantly affected
5.Evolution of condition
Acute or chronic ?
 When did the symptoms start and how have they evolved? Was the onset sudden or gradual?
Associated events
 Was the onset associated with a particular event, e.g. trauma or infection?
Management Hx: •
 Remember to ask about use of medication for pain relief.
 Which treatments has the condition responded to?
 drugs given (steroids, NSAID, methotroxate)
 Physical therapy and rehabilitation, sports activity
 Response to treatment
Complications Hx: drugs S/E, deformity, wheel chair, splinting
6. associated general symptoms (fever, night sweats ,Malaise, weight loss , increase weight or fracture.)
7. Systemic review:
 cardiac (chest pain, exercise intolerance)
 respiratory (cough, SOB)
 Renal: (H.urea ,odema,oligure)
 Eye:redness
 skin rash ….etc.
6. Impact of lifestyle
 Patient’s needs/ aspirations
 Ability to adapt with functional loss
 Daily activities: housing ,eating (TMJ involvement), dressing, writing, walking, limping, school attendance, sport
 Asses social support and rules out depressive disorder
8.Social psychological history
• Asses social support
• Rules out depressive disorder
9. past history (trauma, infection, surgery, medications (steroids) ( laxative excess ), blood transfusion.)
10. Immunization history (esp. polio.)
11.Developmental history (delayed milestones esp. motor, sun exposure, vit D supplementation )
12. Family History (consanguinity, Similar illness , other diseases.)
13.Ask the relative if he has any question or information and thanks
14.Presentation
knee joint pain history taking checklist

3. Open question about the chief Complaint (joint pain)
4. Describe
 Onset (sudden, insidious, acute).
 duration
 Course (progressive, stationary, regressive).
 Aggravating factors (e.g. exercise) or relieving factors (e.g. rest).
 recent hx of trauma/exercise.
5. associated symptoms
• associated joint swelling, tenderness ,decreased mobility, limping.
• associated back and hip pain
• associated constitutional symptoms, fever, fatigue, night sweat , wt loss, increase weight.
6. Systemic review:
 associated skin rash.
 associated GI symptoms (abdominal pain, diarrhea…).
 associated urinary symptoms (hematuria, dysurea…).
 associated eye symptoms (pain & redness).
 cardiac (chest pain, SOB)
 respiratory (cough, exercise intolerance)
 hematological, (bleeding tendency).
7. past history (previous knee pain or other joint, surgery, hx of bleeding disorder or blood transfusion.)
8. Immunization history esp. polio/MMR.
9. Developmental history
10. Family History (family hx of joint disorders)
12.thanks
12.Presentation
/ F.up
Limping history taking checklist

3. Open question about the chief Complaint (Limping)
4. which limb/joint swelling

Onset
 The age of the patient at the onset of limping.
 Onset (sudden, insidious, acute).
 Course (progressive, stationary, regressive).
 Duration.
Painful or painless.
Restrict movement
Aggravating factors (e.g. exercise) or relieving factors (e.g. rest).
5. Systemic symptoms
(fever, joint swelling, tenderness, redness, skin rash ,back pain, knee pain, leg bowing, decrease/ increase weight.)
6. Systemic review:
 cardiac (chest pain, SOB)
 respiratory (URTI, exercise intolerance)
 GIT (UTI, H.urea, skin rash, diarrhea, vomiting)
 Hematological (anemia ,bleeding tendency ).
7. past history (trauma ,surgery, medications (steroids) ( laxative excess ), blood transfusion ,IM injection)
8.perinatal history
 prenatal: maternal infections or diseases, medications
 natal: birth asphyxia, risk factors for DDH (large baby, breech, 1st baby, twins).
 Postnatal: Hx of meningitis, septic arthritis.
9. Immunization history esp. polio.
10.Developmental history delayed milestones esp. motor, sun exposure, vit D supplementation .
11. . Family History (consanguinity, Similar illness , other diseases.)

12 . Nutritional history ( breast feeding or not )
14.thanks
15.Presentation
Joint swelling /Stiffness(arthritis) history taking checklist
3. Open question about the chief Complaint (joint Swelling)
4. HOPI
 Onset / Duration (sudden, insidious, acute , chronic).
 Pattern of joint is involved (mono/ polyarthritis) /Which joint is involved ( small, large or back)
 Course localized/migratory ( progressive, stationary, regressive).
 Aggravating factors (e.g. exercise) , relieving factors (e.g. rest or analgesia).
5.Associated events
 recent history of URTI, skin infection ,diarrhea ,influenza, mumps, rubella, varicella, hepatitis A and B CMV,EBV.
 recent history of trauma or drugs (antibiotics) in the previous 7-12 days(serum sickness)
 recent vaccination /MMR.
6.Local associated symptoms
 Pain History points to elicit can easily be remembered using the mnemonic ‘SOCRATES’ .
 tenderness ,warm, redness
 limitation of movement ,morning stiffness ,limping and leg bowing
7.constitutional symptoms :fever,Arthralgia ,fatigue, skin rash, night sweat , back pain, Weakness, wt loss, increase weight.
8.Management Hx:
 Remember to ask about use of medication for pain relief.
 Which treatments has the condition responded to?
 drugs given (steroids, NSAID, methotroxate)
 Physical therapy and rehabilitation, sports activity
 Complications Hx: drugs S/E, deformity, wheel chair, splinting
9. Systemic review:
 CVS: chest pain, palpitations, CHF symptoms
 Resp: chest pain, dyspnea, cough,…
 GIT: abdominal pain, diarrhea, bloody stool….IBD
 Urinary: hematuria, oliguria ,urthral discharge , HTN,…
 Eye: redness /uveitis, vision, xerosis, cataract
 Neurological: seizures, headache, irritability, psychosis and depression(SLE)
 Hematological: bleeding, fever, Lymphadenopathy, recurrent infection, blood trans .(hemophilia/malignancy)
10. Impact of lifestyle
 Patient’s needs/ aspirations
 Ability to adapt with functional loss
 Daily activities: housing ,eating (TMJ involvement), dressing, writing, walking, limping, school attendance, sport
 Asses social support and rules out depressive disorder
 11.past history
 medical Hx :same illness ,admissions, trauma ,blood transfusions , surgical illnesses or allergy
 Drugs Hx: precipitate arthritis including frusemide , thiazide ,hydralazine, phenytoin, chlorpromazine, INH
 Immunization Hx polio/MMR.
12.Family History (IBD, hemophilia, R.arthritis.)
13.Travel history , Tick exposure (dengue fever/lyme).
14.Ask the relative if he has any question or information and thanks.
15.Presentation
/ F.up
hematological history taking checklist
Pallor /anemia history taking checklist
3. Open question about the chief Complaint (Pallor )
4. Onset and duration (acute or chronic )
 Age
 Iron deficiency rare in the absence of blood loss before 6 mo in term
 Sickle cell anemia and -thalassemia appear as fetal hemoglobin disappears (4-8 mo of age)
 assess the severity :
 ask about tachypnea, altered level of consciousness, coma and urine output (oliguria)
 sit of pallor ( skin, conjunctiva , mucus membrane )
 Ask about jaundice
 urine and stool color
 skeletal anomalies( microcephally, absent radius or thumb )
 skeletal changes( large head, prominent maxilla)
 sever behavioral disorder, MR.
 ask about Blood loss and Recent infections
5. Systemic symptoms (fever , sweeting, loss of wt ,loss of activity , poor appetite ,fatigue, ,sleep pattern )
6. Systemic review:
 CNS (headache ,convulsion ,loss concentration, dizness)
 Renal (colour and amount of urine ,dysuria, loin pain )
 Heamatological (bleeding tendency, bony ache ,joint swelling, lymph node swelling )
 CVS and respiratory (feeding difficulty, Exercise intolerance, shortness of breath, palpitation )
 GIT (diarrhea, jaundice, bloody stool, menorrhagia, )
7. past history (chronic illness , previous admission ,blood transfusion ,drug history (NSIAD) , GIT surgery,trauma )
8.if neonate
 Prenatal :(Torch infection,HTN,DM,drugs …. (
 Natal (SGA or prematurity, -twins , birth trauma, delayed cord clamping , blood group of mother & baby
 Post natal (Phototherapy , Transfusion ,ICB)
11. Family History (Ethnicity and race ,consanguinity, Anemia , Jaundice, hx of hemolytic disease, spleenectomy or
cholecystectomy ,Autoimmune disease ,Bleeding disorders)
12 . Nutritional history : cow milk(IDA), goat's milk: (folate deficiency) , history of pica , vegetarian (B12 deficiency )
Did he receive any iron & didn't improve on tt,
13. Socioeconomic history (daycare, family member, water supply , hygienic condition).
14.travel history.
16.thanks
15.Presentation
/ F.up
Bleeding tendency history taking checklist

3. Open question about the chief Complaint (bleeding tendency)
Age of onset and types
• Neonate - with intracranial haemorrhage or bleeding after circumcision (Haemophilias(
• Toddler - when starting to walk (Haemophilias (
• Adolescent - with menorrhagia (von Willebrand's disease) , epistaxis or joint (Haemophilias)
• Any age Bleeding with surgeries/sutures/dental interventions (Haemophilias)
4.types of bleeding and bruising, including
• epistaxis
• Bleeding with circumcision
• Bleeding with crawling/walking
• Bleeding with surgeries/sutures/dental interventions
• Menorrhagia – pad changes <2h, menses >7days, >1 menstrual period/month
5.Pattern of bleeding
• Mucous membrane bleeding and skin haemorrhage - characteristic of platelet disorders or von Willebrand's disease
• Bleeding into muscles or into joints - characteristic of haemophilia
• Scarring and delayed haemorrhage - suggestive of disorders of connective tissue, e.g. Marfan's syndrome,
osteogenesis imperfecta or factor XIII deficiency
6.Severity of bleeding
• Spontanusly (sever)
• Post minor trauma modreat)
• Post surgeries/sutures/dental interventions or major trauma(mild)
• Systemic illness , pallor , joint hypermobility, convulsion, coma
8.Complications:
 joints: deformities
 Seizure (ICH)
9. Family History
• Family tree - detailed family tree required (siblings,parents,aunts,uncles,grandparents)
• Gender of affected relatives (if all boys, suggests haemophilia)
• Risk factors for non-accidental injury secondary to abuse (Unusual pattern or inconsistent history - consider non-
accidental injury)
10. past history
• blood transfusion
• Previous surgical procedures and dental extractions - if uncomplicated (acquired bleeding tendency)
• Risk factors for non-accidental injury (Unusual pattern or inconsistent history )
11. history of medications
• antiplatelet drugs (nonsteroidal anti-inflammatory drugs)
• anti-coagulants (warfarin,heparin,low-molecular-weight heparin)
• antimetabolites (L-asparaginase)
• prolonged use of antibiotics causing vitamin K deficiency
13.thanks
14.Presentation :Brief introduction,DDx then most likely Dx ,List the problem, Investigation/Rx/ Refer/Advice/reassurance/ F.up
Sickle cell disease crisis history taking/managment checklist

3. Open question about the chief Complaint (pain)
• Asking for pain and offering analgesia outright
• Asking Vitals and correcting them if inappropriate (May need IV hydration)
4.clarify the details of the pain using SOCRATES
• Site – where exactly is the pain / where is the pain worst
• Onset – when did it start? / did it come on suddenly or gradually?
• Character – what does it feel like? (sharp stabbing / dull ache / burning(?
• Radiation – does the pain move anywhere else? (e.g. chest pain with left arm radiation(
• Associations – any other symptoms associated with the pain (e.g. chest pain with SOB(
• Time course – does the pain have a pattern (e.g. worse in the mornings(
• Exacerbating / Relieving factors – anything make it particularly worse or better?
• Severity – on a scale of 0-10, with 0 being no pain & 10 being the worst pain
• fever, DOB, pallor, juandice , joint swelling, convulsion, coma, abdominal pain
6. Histroy of Precipitant:
 Dehydration
 Infection
 alcohol.
7.Complications: Crisis
 Brain: Seizure, Stroke (Children), Bleeds in adults, Coma
 Bone: Pains in humerus, tibia, femur (Avascular Necrosis), Vertebra
 Acute Chest syndrome +/- fever , Pain
 abdomen: Splenic Sequestration
 aplastic/hyperhemolytic crisis
 Priapism
 Skin Ulcers
8. past history (previous admission, blood transfusion ,surgery)
9. Immunization history ( Influenza and Pneumococcal).
10. medications
• folic acid and prophylactic penicillin
10. Family History
11.Investigations
• FBC, Reticulocyte Count, CXR, Septic Screen
12.Treatment:
• IV Analgesia
• IV Hydration
• Hemotologist review
• Admit
endocrine history taking checklist
Short stature history taking checklist
 What is the age of the person with short stature?
 from birth in SGA ,IUGR , primordial
 early in cystic fibrosis
 after 1st yr in GH deficiency
 in celiac IBD occurs latter
 What is the type of short stature (proportional or disproportional short stature)
 Ask if dysmorphic or no
 general health (healthy or ill )
 obese or thin
 mature or immature
 mentaly health or retarded
4 . Systemic symptoms :
 CNS : symptoms of ICP, polyuria( masses of the CNS ),Visual field deficits headache or diplopia (pituitary neoplasms)
 GIT: chronic diarrhea flatulence, or borborygmi (malabsorption ,coeliac disease), hepatosplenomegaly(MPS) abd pain and Blood
in stools may indicate inflammatory bowel disease , constipation (hypothyroidism)
 Chronic infections: Poor wound healing and opportunistic infections are signs of potential immune deficiency.
 Renal (colour , amount of urine, polyuria ,odema )
 Ortho : bony ache ,joint pain and swelling (JIA or IBD), multiple fractures ,deformities (OI )
 CVS (Exercise intolerance, shortness of breath ,peripheral edema, murmurs, and cyanosis)
 Respiratory: chronic cough , wheeze, noisy breathing ,sleep apnea , previous use of puffers(BA,CF)
 Endocrine : neck swelling ,cold intolerance (goiter), acne, headaches, hairsutism (Cushing's). polyurea ,plydypsia (DM)
5.Antinatal history (take detail history if short since birth)
• Prenatal: - stillbirths, IUGR ,torch infection ,Hypertension/,Toxins (e.g. drugs,alcohol) ,placental insufficiency, Malnutrition
• Perinatal: wt,ht HC ,SGA , Prematurity , hypoglycaemia , microphallus , ambigpus gentalia ,dysmorphism , birth defects
• Postnatal: TFT screen
6.past history : (previous measurements see growth and velocity if follow or cross the centile chart)
• history of chronic illness (BA ,CF,IBD,DM,caeliac ) ,admission ,operation ,recurrent infection (ask about vaccination)
• history of CNS affection (tumor ,irradiation, meningitis ,head trauma)
• history of malnutrition ,FTT
• history of endocrinopathy + obesity (hypothyroidism,cushing , DM)
• history of regular drug use (Long-term steroid administration,insuline and ADHD treatment-Ritalin)
• past history previous investigation or previous professional involved
7.Developmental and puberty history
 motor, hearing ,vision,social skills and learning,school performance(delayed in psychosocial deprivation/ syndromic SS)
7. Family history .
• parents’ and siblings’ short stature or delay puberty (over to check MPH( (parallel to calculated MPH)
• age at onset of menarche of child's mother (Late maternal menarche suggests familial maturational delay)
• the age of adult height attainment for the father' (late bloomer' suggest constitutional delay)
• history of consanguinity , syndromic or congenital anomalies ,genetic disorders, deaths in infancy, dwarfism, hypothyroidism
8. social and psychological history .
• sense of security and of being loved ,raise any suspicion of emotional neglection, abuse, or starvation.
 History of participation in sports that require weight control or, bingeing, purging, (suggests AN/NB)
 appetite ,frequency, type ,caloric intake and access to food ,neglect
 psychosocial problem such insomnia ,depression, psychosis
8. social and psychological history .
 appetite ,frequency, type ,caloric intake and access to food ,neglect

11.thanks
Tall stature history taking checklist
• What is the age of the person with tall stature? What is the type of tall stature (proportional or Long-legged,syndromic )
• Early syndromic proportionate tall stature at birth
• rubinstein taybi/large hands and feet
• Sotos/ gigantism
• BWDS/macrosomia,hypoglycaemia
• late non syndromic proportionate tall stature
• familial,Constitutional ,hyperthyroidism)
• late syndromic Long-legged tall st.
• thin with hypermobility , scoliosis and learning disabilities (Marfan's syndrome )
• thin with Immature , Cryptorchidism and mental retarded (Klinefelter's syndrome, XXY syndrome)
• thin with restricted joint and mental retarded (homocystinurea)
4.General health , well or ill ,obese or thin
• healthy (familial ) ,obese (Constitutional obesity) ,ill and thin (hyperthyroidism)
5 . Systemic symptoms :
 CNS : seizure (homocystinurea)
 GIT: chronic diarrhea(hyperthyroidism)
• getourinary : undescending testes(Klinefelter's syndrome, XXY syndrome) ,ambigouse gentalia(CAH)
 Ortho : bony ache ,restricted joint , (homocystinurea) hypermobility (Marfan's syndrome )
 CVS (Exercise intolerance, tachycardia(hyperthyroidism) ,shortness of breath , , murmurs –MVP AR)
 Respiratory: noisy breathing ,DOB (Marfan's)
 Endocrine : anxiety ,hot intolerance (hyperthyroidism)
 Hematology : thrombosis (homocystinurea)
6.Antinatal history
• Prenatal: - maternal DM ,drugs ,CAH ,hyperthyroidism
• Perinatal: wt,ht HC , LGA macrosomia, birth trauma(IDM) ,hypoglycaemia(BWDS) , ambigouse gentalia(CAH)
• Postnatal: dysmorphism (rubinstein taybi/large hands and feet)(Sotos/ gigantism)(BWDS/macrosomia,hypoglycaemia
7.Developmental and puberty history
 Developmental delayed , MR and delay puberty in Marfan's Klinefelter's , XXY syndromic homocystinurea
• precocious puberty in Constitutional obesity
8. Family history .
• parents’ tall stature (over to check MPH which parallel to calculated MPH)
• history of consanguinity , syndromic or congenital anomalies ,genetic disorders, gigantism or hyperthyroidism
10.thanks
precocious puberty history taking checklist
 At what age did you first notice changes of puberty? (before the age of 9 in boy and < 8 years in girls)
 is it really precocious puberty? accompanied by normal chronology of physical change but earlier with a growth spurt or
 discordant puberty (abnormal pattern) Premature adrenarch /pubarche or Premature thelarche
 What is the type of precocious puberty?
 central, 'true' PP : there breast or testicular enlargement
 Peripheral pseudo, 'false' PP : acne and pupic hair or breast development
4. what first notice changes of puberty? (Chronology of physical change ,growth sprut ,onset of menesis)
 normally In females - breast (8.5 - 12.5 y) then pubic hair and a rapid height spurt then 2.5 years latter menarche
 In males: testicular enlargement then pubic hair (10 and 14 years) then height spurt
 Symptoms of early puberty in male? (< 9 in boys enlargement of the scrotum, testicles and penis; pubic hair growth ).
 symptoms of early puberty in female? (< 8 breast budding occurring , or first menstrual period < 9).
 Musculinisation in female with precocious puberty (deepening voice, acne, loss of mensis, hairiness, enlargement of clitoris)
 adult body odour
5. Systemic symptoms (fever, loss /increase weight ,loss appetite ,sweeting and sleep pattern)
6.History of complication
 Short stature , psychological stress
7.Review of symptoms:
• CNS : Visual field deficits ,behavioral change ,headache or diplopia (pinealoma)
• Endocrine : short stature ,coarse face ,cold intolerance(hypothyroidism) moon face , truncal obesity (Cushing's syndrome)
• GIT: constipation(hypothyroidism) ,abdominal mass (Ovarian cysts /tumors) (hepatoblastoma)
• getourinary : testes swelling or shrinkage (Sertoli cell /Leydig cell tumors) , girl ambigouse gentalia (CAH)
• Ortho : bony ache ,joint pain and deformities (McCune-Albright syndrome )
• Skin : café au lait spot(McCune-Albright syndrome ) ,fibroma (NF), thin skin(Cushing's syndrome)
• Prenatal: - maternal CAH , drugs exposed (androgen)
• Perinatal: ambiguous gentiles
• Postnatal: vomiting , hypoglycemia , dehydration or shock
9. past History of CNS affection
 Previous infection of CNS (meningoencephalitis,absess ,granuloma)
 Brain tumer Hypothalamic hamartomas astrocytomas, ependymomas ,
 Congenital defects (hydrocephalus, cysts, septooptic dysplasia)
 Major head trauma
 Past CNS surgery , irridation
 Neurofibromatosis (with or without a hypothalamic optic glioma)
10. Past History of
 Hypothyroidism (prolonged and untreated )
 Cushing's syndrome
 McCune-Albright Syndrome
11. Past History of Medications?
 Usage of birth control pills in female
 anabolic steroids in males to increase their body mass
 corticosteroids may cause a Cushing's syndrome
12. developmental history (Short /tall stature)
13 Family history of
 consangulity , ambiguous gentiles or other diseases
 What age did the parents enter puberty?
14. Ask relative if he has Any question and thanks
Delay puberty history taking checklist >15 years in boys and >14 years in girls)
 Have you ever any sign of puberty ?
 What age at onset of androgen (testes enlarged) and estrogen signs (breast development)?
 What genitalia size and shape at birth ,ambiguous gentiles?
 Ask if look syndromic (Turner's short girl, tall Klinefelter's, XXY boy) (tall boy or girl kallmann)
5. History of complication (Short stature , psychological stress ,depression, psychosis)
6.Review of symptoms: (mainly boy)
• CNS : vision problems, headache, vomiting, inability to detect odors.
• Endocrine :adrenal insufficiency (hyperpigmentation),hypothyroidism (short stature ,coarse face ,cold intolerance)
• Chronic infections: Poor wound healing and opportunistic infections are signs of potential immune deficiency(CF).
• GIT: chronic diarrhea flatulence (malabsorption ,coeliac disease), abd pain and Blood in stools (IBD)
• Respiratory: chronic cough , wheeze, noisy breathing ,sleep apnea , previous use of puffers(BA,CF)
• Renal (colour , amount of urine, polyuria ,odema )
• Ortho : bony ache ,joint pain and swelling (JIA or IBD), multiple fractures ,deformities (OI )
• CVS (Exercise intolerance, shortness of breath ,peripheral edema, murmurs, and cyanosis)
7. past History
boy
 chronic illness : Cystic fibrosis ,severe asthma, Crohn's disease, CRF,
 CNS affection : Brain surgery ,Intracranial tumours (including craniopharyngioma)
 Acquired gonadal damage : Post-surgery ,Chemotherapy ,Radiotherapy ,Trauma ,torsion of the testis
 previous investigation or previous professional involved
girls
 hypothyroidism,addison disease
 malnutrition
 Medications? of anabolic steroids?
 History of participation in sports that require weight control or, bingeing, purging, suggests AN/NB
8. developmental history (Short /tall stature)
9.Family and social history
• is there a family history of delayed puberty/ late menarche?
• timing of maternal and paternal growth and pubertal development
• sense of security and of being loved ,raise any suspicion of emotional neglection, abuse, or starvation.
111.thanks
12.Presentation
Ambiguous gentile history taking checklist
 is it Pseudohermaphroditism
 Virilized female? / Ovaries only /46,XX /high androgen
 Inadequately virilized male/ Testicles only /46,XYP
 Gonadotrophin insufficiency with (small penis and cryptorchidism) Prader–Willi syndrome congenital hypopituitarism
 or
 True hermaphroditism (Ovotesticular disorder)
 Mixed gonadal Dysgenesis
 Pure gonadal dysgenesis
4. At what age did you first notice? what you notice?
 Female with early neonatal ambiguous gentiles? (CAH ).
 female with delay puberty? ( male with Androgen insensitivity(testicular Femenazation syndrom)
 Male with early small penis and cryptorchidism (congenital hypopituitarism,Prader–Willi syndrome )
5. growth and developmental history
 Ask if gonads palpable or no?
 Has ever any sign of puberty (delay or precicous) ?
 Ask about growth (Short /tall stature)
 Ask about sexual life
 psychological stress
8.Review of symptoms:
• CNS : Visual field deficits ,behavioral change ,headache or diplopia (pinealoma)
• Endocrine : short stature ,obesity ,delay pubirty
• GIT: abdominal mass (Ovarian cysts /tumors) (hepatoblastoma)
• getourinary : small penis and cryptorchidism ,h.urea ,renal mass(wilms tumor)
Prenatal: -
• maternal CAH drugs exposed(androgen) (prenatal screen) ,previous CAH ,metabolic dis or neonatal death
Perinatal:
• What genitalia size and shape at birth (CAH ,hypogonadism )
• small penis and cryptorchidism (hypogonadism)
• syndromic face ( Denys-Drash syndrome) (WAGR syndrome )
Postnatal:
 vomiting , hypoglycemia , dehydration or shock
 ask about previous investigation, medication
8. family and social history

 Consagulity ,CAH
Thyroid Problems history taking checklist
3. Open question about the chief Complaint (Thyroid Problems)
 What age at onset of symptom
 S//S hyper- or hypothyroidism
 Neck swelling (goiter)
4.Past Treatment or Evaluation :
ask about previous investigation
medication :Thyroid hormone ; antithyroid agents—propylthiouracil (PTU); methimazole (Tapazole); beta blockers; lithium.
5. Systemic symptoms
• Prominent eyes
• heat or cold intolerance
• change in skin or hair texture and distribution;
• voice change;
• anxiety/depression
• neck mass or pain
• change in bowel or menstrual patterns
• change in weight, appetite
6.Review of symptoms: (mainly boy)
• CNS : vision problems, headache, vomiting, Mood Disorder: Depression ,anexity, MR
• Endocrine : obesity ,short/tall stature ,coarse face ,cold /hot intolerance, hyperpigmentation ,DM
• GIT: chronic diarrhea ,constipation
• CVS : Exercise intolerance, shortness of breath ,tachy /bradycardia ,palpitation
• Ortho : bony ache ,joint pain and swelling
• Hair and skin:
7. past History
Antinatal history (take detail history if start since birth)
• maternal thyroid problem , drugs Lithium Amiodarone
• neonatal screen for TSH, hypoglycemia ,prolonged jaundice, feeding problem,1st time pass stool ,constipation
medical history
• hyper- or hypothyroidism; goiter; thyroid surgery or radioactive treatment of thyroid.
• Down's or Turner's syndrome
• Cardiovascular disease
• eye disease
• autoimmune disease (DM ,Addison's disease )
• head trauma ,surgery ,tumor ,radiation
•
8. developmental history (Short /tall stature)(delay /precious puberty)(menses disturbance)
9.social history : learning difficulty, behaviour problems ,Psychosis
10.Family history
• Thyroid disorders
• Endocrine disorders
• Autoimmune disorders
DM history taking checklist
3. Open question about the chief Complaint and HOPI (poor control/complication) Presenting condition :
• -Have you been very thirsty? Do you drink a lot?
• -Have you been urinating more than usual?
• -Has the child had any bedwetting episodes?
• -Has there been any recent weight loss?
• -Have you been feeling tired lately?
• -Have you noticed an increased appetite lately?
• - Has the child had more frequent minor skin infections?
4. Systemic symptoms (fever ,palpitation, angry ,sweeting , poor appetite, lethargy ,fatigue, poor sleep ).
5. precipitating event (heavy meal ,omit insulin ,low dose ,intercurrent illness (viral infections recently or stress)
6. Systemic review:
 CNS (coma, convulsion ,symptoms of increased ICP,ICH, motor or sensory symptoms, blurred vision, blindness )
 CVS (Exercise intolerance, shortness of breath, orthopnea ,palpitation )
 Respiratory system (Cough ,Tachypnea = reflects acidosis. )
 GIT : (abd. Pain,nausea, vomiting ,diarrhea, constipation )
 Renal (polyuria ,dysuria, urgency ,frequency )
 Endocrine (loss of wt , poor growth)
 Skin (lipodystrophy, pigmentation ,minor skin infection)
7. Initial diagnosis
 age at Dx / Intervention needed (?PICU) / Length of hospital stay /Education given
8. Past management history
 past ketoacidosis, coma
 number of hospitalisations (including PICU)
 Frequency of monitoring
 Changes of management
 Complications of treatment (lipohypertrophy ,hypoglycemic spells (insulin "reactions)
 sensory change ,kidney disease; urinary tract infection ,obesity
9.Current treatment
 Type of insulin and duration of this treatment
 Modifications for sport, etc, .
 Frequency of monitoring
 Dietary adaptations (is there a dietician involved?)
10.Family history:
• Are there any family members with insulin-dependent diabetes mellitus?
• Are there any family members with autoimmune conditions?
11.Social history
Effects on child:
 Understanding of disease and long-term complications
 Effects on friends and school
 Any involvement in diabetic camps/g. oups?
Effect on family:
 Siblings' understanding of disease
 Involvement of social worker
 Change of family's diet
12.Ask the relative or patient if he has any question or information / thanks .
Communication (explanation and consultation) checklist
General communication skill checklist
1. Introduction of self and task
• “Hi my name is… and I have been asked to”…

• “Hi my name is… and I understand you had some questions about…”
2. What do they already know (and from whom)
• “Can I just check what you have been told about…”

3 . What do they want to know
• “But before I begin, is there anything in particular that concerns you/ you want to talk
about?”
4. Tell them what you are going to tell them/ what you are going to discuss
• “First, I am going to explain… then”…Tell them/ discuss the issue
5. Check understanding
• “I know I’ve given you a lot to think about, so I just wanted to check whether I have done
this in a way you can understand by asking you to summarise the important bits back to
me”
6. Opportunity to ask questions
• “Is there anything else you would like to ask about?”
7. Closure/ safety netting
• “If you think of any other questions after this, write them down and I will come back a bit
later to discuss them with you”
18. Thank you
Insulin administration explanation checklist:.
3 . Explain procedure (painless , need to take daily)

4. Tells about the two insulin (Milky and Plain) and insulin syringe
5.To give 15-30 minutes before food
6. Remove half an hour before from fridge and shake lightly
7. Select areas –mark them for every day => thigh and site rotation
8. Swab the top of the vial with spirit swab provided
9. Takes 4U air in a syringe puts it in insulatard vial (keeping thevial upright) and then takes 6U
air in a syringe puts it in actrapid vial(vial upright)
10. Inverts the bottle withdraws 6u actrapid then withdraws syringe inserts in insulatard and
withdraws up to 10u i.e. 4u
11. Cleans area with spirit
12. Allows it to dry
13. Pinches the subcutaneous area –inserts the needle at 45 degree angle and injects then
withdraws needle with syringe and slowly releases pinch, no rubbing massaging
14. Syringe reusable/disposal in sharp
15. Can use same needle for 2-3 times
16. Keep insulin in fridge
17. Explain the symptoms of Hypoglycemia
18. Thank you
Epilepsy management counseling checklist:
1.Initial approach to the patient (Welcoming mother Introduces yourself, explains what you will be doing)
2. General information about epilepsy
• Explain what epilepsy is.
• Diagnosis
• Reasons for tests and what the results mean
• Seizure type and syndrome
• Prognosis
Treatment options
• AEDs, including indications, side effects, and licence status
• Action to be taken after a missed dose or after a gastrointestinal upset
• Reasons for referral (e.g. for surgery)
Lifestyle
• Independent living
• Future career opportunities and decisions
• Insurance issues
• Driving
• Alcohol
• Recreational drugs
• Sexual activity
• Sleep deprivation
• Family planning
3. Safety
• First aid
• Safety in the home
• Status epilepticus
• Road safety
4. Support
• Support organisations (including contact details(
• Claiming benefits
• Support from social services
11. explain which time for seek help and get the ER
13.Thanks mother
Epilepsy structured review (F. up) counseling checklist:
2. Consider treatment:
• Effectiveness /tolerability /side effects /adherence
2.Discuss the treatment plan and potential lifestyle issues
3.Ensure access information
• counselling services
• epilepsy specialist nurses
• timely and appropriate investigations
• referral to tertiary care (including surgery) where appropriate
4. Safety
• First aid for Prolonged or repeated seizures and Status epilepticus (rectal diazepam Or buccal midazolama)
• Safety in the home (bathing and showering)
• Road safety
• explain which time for seek help and get to ER
5.Sudden unexpected death in epilepsy (SUDEP)
• There should be tailored information and discussion about the child’s relative risk of SUDEP of nocturnal seizures
6. information about sexual live and contraception for young women of childbearing potential with HEI -AED
• the progesterone-only contraceptive pill and progesterone implant is not recommended
• combined oral contraceptive pill , oestrogen and depot injections of progesterone is recommended
• discuss additional barrier methods.
• Emergency contraception:levonorgestrel should be increased to 1.5 mg and 750 micrograms 12 hours apart.
7.given information about pregnancy and breastfeeding with AEDs.
• potential risk of harm to the unborn child associated with different AEDs
• assess the risks and benefits of the individual drugs(Lomatragin instead of valoprat).
• need for folate
• genetic counselling
• need for vitamin K for the newborn child.
• breastfeeding while taking AEDs
8. given information about for Special groups /children with learning disabilities
• Rx by specialist working within amultidisciplinary team
• Considerneuropsychological assessment
• There is a higher mortality risk
9. Support
• Support organisations (including contact details)
• Claiming benefits
• Support from social services
11.Thanks mother
Febrile seizure counseling checklist:
2. Explain what a simple febrile and a complex febrile seizure is.
3. Ask for family history febrile convulsions
4. Ask for history of seizures
5. Ask for history of neurodevelopment
6. explain use of antipyretics
7. explain use of hydrotherapy

8. explain intermittent prophylaxis (antipyretics, diazepam, clobazam)
9. explain management of a seizure at home

10. explain which time for seek help and get the ER
11. explain risk of future epilepsy
13.Thanks mother
Lumbar Puncture counseling checklist:
1. Initial approach to the patient (Introduces him/herself, explains what he/she will be doing)
2. Refer to parent and child by name
3. Welcoming mother
4. Appropriate eye to eye contact
5. Appropriate body language
6. Sympathy with mother and patient
7. Reassurance of mother
8. Clear explanation about LP, why is it necessary and what is involv ed
9. Explain about analgesia

10. Explain Benefits
 Confirm diagnosis and management, selection of treatment, length of treatment, follow-up arrangement
11. Explain risk  Infection, leak, headache
12. Answer honestly regarding risk of paralysis
14. Offer follow-up
15.Thanks
Pre-operative assessment and counseling checklist:
1.Initial approach to the patient (Introduces him/herself, explains what he/she will be doing)
2.Welcoming pt and mother
3. Asks whether patient has ever had surgery before
4. Addresses patient’s and parent fears
5. 4. Mentions need to stop solids from 6 hours before the operation
6. Mentions need to stop milky drinks from 4 hours before the operation
7. Mentions need to stop clear fluids from 2 hours before the operation
8. Explains that pre-medication can be given to help with anxiety

9. Explains the anaesthetic procedure
10. Explains that patient may feel sick after the operation
11. Explains that patient may feel pain after the operation
12. Discusses post-operative pain relief
13. Discusses going home
14.Elicits and addresses any remaining questions and concerns
15.Thanks
Breaking bad news counseling checklist
1.Initial approach to the parents (Introduces your)
2. Looks to parent’s comfort and privacy
3. determines what they already knows

4. Establishes their outlook on the situation
5. Warns them that bad news is coming
6. Breaks the bad news
7. Gives them time to respond
8. Encourages her to express her emotions
9. Empathises with their emotions

10. Seeks to address those concern
11. Ensures that there is someone with her when she leaves
12.Thanks
The angry parents or relative counseling checklist
2. Explains the problem
3. Acknowledges parent’s anger

4. Establishes their outlook on the situation
5. Gives them the opportunity to vent his anger
6. Explores the reasons for his anger
7. Validates his feelings
8. Gives them the opportunity to express those feelings
9. Offers to do something for them

10.Thanks
Blood glucose measurement (glucometer) explanation checklist
1.Initial approach to the parents
 Introduces your
 explain procedure
 ask for consent
 wash hands
2. establish when patient last ate
3. Checks that test strips have not expired

5. Explains and demonstrates how to use:
 clean target finger with an alcohol wipe
 massage finger
 Ensures that glucose monitor is calibrated
 Inserts a test strip into the glucose monitor
 Inserts the lancet into the pricker
 Indicates need to don gloves
 prick side of finger
 squeeze finger
 test strip sensor to be fully covered in blood
 stop bleeding with cotton wool seal lips around mouthpiece
 explain the parent about result
6. Asks patient to carry out procedure
7. Explains the parent the target result need to achieved and day and nighttime and frequency to check
8. Explains the parent how keep diary of result and how can read previous readings
9.Explains the parent when and how
10. thanks
Breastfeeding technique counseling checklist
1.Initial approach to the mother
2. Open the discussion
3. History
• Past pregnancy history (examples include number of pregnancies, labor complications, term or
• Breastfeeding history (examples include breastfeeding experience with other children, age child
• weaned, breastfeeding difficulties, why breastfeeding discontinued)
• Current breastfeeding interest (examples include your interest in breastfeeding now, what you have
• heard about breastfeeding, how is breastfeeding going, any questions regarding breastfeeding)
• Past medical history
• Current medications (prescription, over the counter and alternative)
• Medication allergies
• Alcohol, tobacco and recreational drugs
4. Educated me about how to optimize baby’s attachment to breast
 “C” hold of breast
 Proper alignment of infant, mouth at nipple level
 Mother tickles infant’s lower lip
 Cheeks not sucked in
 Cradle, football, and side by side
 Bring baby to breast instead of bringing baby to nipple
 Clicking sounds means baby is not properly attached
 Comfortable sitting position
5. How to avoid sore, cracked nipples

6. Timing (examples include how often baby should breastfeed, how long on each breast, use of both breasts)
7. Avoidance of use of formula unless medically advised
8.Advice on maternal self-care (examples include treat pain adequately [narcotics OK], hydration ,
additional 500 calories per day, rest, have support)
9.Other resources (examples include provider, nurse, La Leche League, lactation consultant)
Breastfeeding counseling checklist
Introduction
 Patient Opening
 Agenda setting
3. Build a relationship
• Listening
• Empathy and attitude
• Nonverbal behavior
4. Gather information
 Context
 Questions
 Organization and transitions
 Physical examination
 Personal privacy
5. Understand the patient’s perspective
 Patient concerns
 Patient beliefs and preferences
 Expression of feelings
 Specific circumstances
6. Share information
 Vocabulary
 Patient understanding of illness
 Clinician information and explanation
7. Reach agreement (planning, evaluation, and treatment)
 Negotiation
 Implementation
8. Provide closure
 Patient next steps
 Physician conclusion
Counseling formula against Breastfeeding checklist
3. explain the different between breast milk stool and diarrhea
4. explain the infant colic
5. explain urination
6. reassurance about wt. gain
7. Educated her about how to optimize baby’s attachment to breast(correct position)
8. explain expression and storage of milk
9. regular F,up
10. explain hazards of formula milk
11. Ask mother if they have any more question
12.thanks mother
Counseling mother whose child has been Dx hemophilia checklist
1.Initial approach to the mother (Greeting ,Introduce yourself, explain what you will be doing )
2. explain disease
3. problem address (current problem JT bleeding
4. associated symptom
5. Rx (drugs ,dose, side effect /FVIIIcryo/FFP)
6. on disharge (precausion at home)
7. inform about future treatment intervention
8.counsle for future pregnancy (prenatal Dx and other family member)
9. investigation for other family member
10.school and play
11.future care and vaccination
12.when Fup
13.inform when come to ER
15.thanks mother
Counseling mother whose child has been Dx with +ve HIV(ELISA) checklist
2. explain disease
3. problem address
4. need to confirm 2nd test /PCR
5. investigation for other family member
6. Rx (drugs ARV, side effect ,where drugs available ,cost ,free )
7.other investigation
8.PCR prophlaxis (when need)
9. vaccination
10.no discrimination
11.school and play
12. inform about future care and vaccination may come up
13.when Fup
14. when to come to ER
15.thanks mother
Counseling mother whose child has been Dx nephrotic syndrome checklist
2. explain disease
3natural history (good prognosis)
4. Rx (drugs steroid resistance/dependence and other modalities )
5. monitor (urine ,BP on Rx)
6.dait (low fat ,normal protein)
7. vaccination (when ,which)
8. F.up
9. Rx (drugs ARV, side effect ,where drugs available ,cost ,free )
10.keep watch about (relapse ,infection ,peritonitis,diarrhea)
11.normalicy of live and school
12. repeated counseling
14.thanks mother
PEFR meter explanation and counseling checklist
1.Initial approach to the parents (Introduces your self / Wash hands )
2.Check patient details – name & DOB

3. Checks patient’s understanding of asthma
4. Explains purpose and importance of PEFR meter

 “I’d like to assess your breathing”
 “This involves measuring how well the air can flow out of the lungs”
 “It’s an important test, as it gives an indication of how well your asthma is controlled”
 Explains when PEFR meter is to be used
5.Gain consent – “Do you understand everything I’ve said?” “Are you happy to go ahead with this?”
6. Explains and demonstrates how to:
 attach a clean mouthpiece
 slide the marker down to the bottom of the numbered scale set to zero
 stand or sit up straight
 hold the meter horizontal
 take as deep a breath as possible
 seal lips around mouthpiece
 exhale as hard as possible into the meter
 read and record the meter reading
 Explains need to repeat procedure at least three times
 The highest reading of the 3 should be taken as the overall result
7. To complete the procedure… Asks patient to carry out procedure
8.Wash hands
9. Checks score against peak flow chart or previous readings
10. thanks
Inhaler explanation and counseling checklist
2. Checks patient’s understanding of asthma
3. Explains what inhaler device

4. Explains when inhaler device is to be used
5. Explains and demonstrates how to:
 attach a clean mouthpiece
 vigorously shake inhaler
 remove cap from mouthpiece
 hold inhaler
 position inhaler
 breathe out completely
 breathe in deeply and simultaneously activate inhaler
 hold breath for 10 seconds before breathing out
 repeat procedure after one minute if required
5. Asks patient to carry out procedure

6. thanks

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History taking checklist

Neurodevelopment history taking page 51

Locomotors history taking page 56

hematological history taking page 60

endocrine history taking page 63

Communication (explanation and consultation) checklist page 70

1. Introduction (Initial approach to the patient ) (Interview)

 congenital and syndromic lymphedema

1.Initial approach to the patient

2. personal data , Refer to the child by name

4.HOPI For each symptom describe :

2. personal data , Refer to the child by name

3. Open question about the chief Complaint (Cough)

4.HOPI For each symptom describe :

4. Onset of the wheezing (sudden ,gradual )

5.associated symptom : cough ,cold, fever, poor feeding ,wt loss

Natal (time and mode of delivery ,need for resuscitatioin , preterm )

2. personal data , Refer to the child by name

3. Open question about the chief Complaint (DOB)

4.HOPI For each symptom describe :

2. personal data , Refer to the child by name

3. Open question about the chief Complaint (Cough ,DOB ,wheezing)

4.HOPI For each symptom describe :

14.Ask the relative or patient if he has any question or information

2.personal data , Refer to the child by name

4.HOPI symptom describe

5.Precipitating and Relieving factors

7. Past medical history, especially:

8. Surgical history, especially:

9 . family history : Down syndrome , Hypothyroidism

11. At the end to ask if there is any more questions

8. Family History: (Similar illness ).

2.personal data , Refer to the child by name

12 .nutritional history (red foods, red drink)

2.personal data , Refer to the child by name

4 : onset & duration.

12 nutritional history (red foods, red drink)

10. vaccination history

2.personal data , Refer to the child by name

7.Asks about physical exercise

8.Asks about menstrual periods

9.Asks about common medical complications of eating disorders

10.Asks about common psychiatric complications of eating disorders

11.Asks about effect of eating disorder on patient’s life

12. Family History: (Similar illness , eating disorder,mental illness)

13. Socioeconomic history (income ,education of family )

8. Family History: (Similar illness ).

10.Ask the relative if he has any question or information.

12.Ask the relative if he has any question or information.

12.Ask the relative or patient if he has any question or information .

4.HOPI : Asks specifically about:

9 . History of stressful events and other psychosocial history including abuse

11.Developmental history time of milestones (Motor ,hearing ,vision ,toilet trained(

12. Family History: of enuresis

14.Ask the relative or patient if he has any question or information .

1.Initial approach to the patient

2.personal data (age) , Refer to the child by name

4 : Ask about general health at moment

7.Confirm and discussed previous Dx

7. Ask about source of the fever

2.personal data , Refer to the child by name

3. Open question about the chief Complaint