Step2 CS question

[skk3]

Any advice on pediatric cases? The questions are a bit different from the typical "abdominal pain" chief complaint. Any input?

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[thehundredthone]

Remember to ask what time the symptom usually sets in (if episodic), and if the symptom is present on holidays. Also ask how the symptom affects the child, and the parent(s). The child's behaviour after the resolution of the symptom is another good question to ask. With pediatric cases, apart from ominous diagnoses, you should ask questions that would aid a diagnosis of "normal childhood behaviour" (which can arise with or without a stressor - which you should ask about as well).

 

[mercaptovizadeh]

Make sure you ask about sick contacts, daycare, home environment, etc. and put the patient's age into the context of the symptoms, as these often play into pediatric cases. Approach it just like any other case, pediatrics will tend to have a narrower differential than medicine

 

[skk3]

thank you for the helpful input. Is it a safe assumption that the child will likely have a infectious etiology? Also, any counseling topics I should definitely hit?

 

[thehundredthone]

No, it's not safe to assume so. That's where one tends to go wrong on the CS, not asking questions that could give you the pertinent positives/negatives to rule in/out diagnoses. You have a whole 15 minutes to take a history and counsel, use the time to get a more thorough history than you would on a normal case. Make sure to counsel the patient about bringing the child in for a full workup and reassert that the workup is needed before you can positively say there's nothing to worry about.

 

[mercaptovizadeh]

I agree that it is not safe to assume that it is infection, but infection does seem to be the most common etiology in children. But by all means you could have anything from intussusception to cystic fibrosis to eczema. Also agree that it is critical to be reserved with a diagnosis to the mother in the absence of a physical exam.

 

[thehundredthone]

I agree that it is not safe to assume that it is infection, but infection does seem to be the most common etiology in children. But by all means you could have anything from intussusception to cystic fibrosis to eczema.

Agreed. However that is something that should be reserved for the diagnosis section of the patient note, and should not bias your history taking. Very often the cases are intentionally vague with a history that does not clearly fit a certain diagnosis, and with the repeated emphasis on pertinent negatives, I would say one should err on the side of caution and have asked the questions (rather than leave them out of the history/erroneously put them down as false negatives).

 

[csprep123]

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