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Test 1: History and examination

  1. What is the first step in the general examination of a child?
    • Introduce yourself.
    • Take a brief history.
    • Do a physical examination.
    • Get a chest X-ray.
  2. How should you address a child?
    • Speak to the mother rather than to the child.
    • It is best to call all children ‘kid’ so that you do not frighten them.
    • Speak directly to the child using the child’s name.
    • It is better if a nurse rather than a doctor speaks to the child.
  3. Is it important to listen to what mothers have to say?
    • Yes, as the mother knows the child best.
    • Yes, as the mother will be paying for the visit.
    • No, as the mother expects you to tell her what the symptoms are.
    • No, as mothers do not give an accurate history.
  4. What is the value of a referral letter?
    • Of little value as the information is often incorrect.
    • Only important if it was written by a doctor.
    • Useful documentation to keep in the patient’s folder.
    • Helpful in drawing your attention to the presenting problem.
  5. The Road-to-Health Card should be asked for:
    • Only at an immunisation clinic.
    • At all clinic visits but not at a hospital visits.
    • Only when the child is seen by a nurse.
    • Always look at the Road-to-Health Card when a child attends any clinic or hospital.
  6. Knowing the child’s age is important because:
    • A doctor rather than a nurse should see all children under 3 months of age.
    • An accurate age is needed to plot the child’s weight on the growth chart.
    • Head circumference should be routinely measured in all children older than 2 years.
    • Notes should be recorded in the Road-to-Health Card only in children younger than 2 years.
  7. How should you measure a child’s temperature?
    • The axillary temperature is best in young children.
    • The oral temperature should be recorded in all children.
    • A rectal temperature is best in older children.
    • Digital thermometers should not be used in children as they are inaccurate.
  8. Who should give the history?
    • The child if possible.
    • The mother or guardian.
    • The referring doctor or nurse.
    • The nurse should take the history from the mother and then tell the doctor the important points.
  9. An immunisation history is important:
    • Only in children from a poor home.
    • Only in children younger than 3 years.
    • If the child attends a clinic but not needed for hospital admissions.
    • Important for all children.
  10. A social history should be taken:
    • Only if you suspect child abuse.
    • Always, as the home situation is often the cause of the child’s problem.
    • Always, as you need not examine the child if there is an obvious social problem.
    • Only in children who are not able to give a history themselves.
  11. How should you start a physical examination?
    • With a general inspection of the child.
    • Always listen to the heart first before the child starts to cry.
    • Always examine the ears and throat first to get the worst part over.
    • There is no need for any special order in performing the examination.
  12. When you examine a child’s abdomen you should first:
    • Auscultate (listen).
    • Palpate (feel).
    • Percuss (both listen and feel).
    • Inspect (look).
  13. When performing the examination:
    • It is best if the parents are asked to leave the room.
    • It is important to have warm hands.
    • A nurse should hold the child still.
    • Always place the child on an examination table.
  14. Should children be undressed for a physical examination?
    • Only if the child appears to be ill.
    • All children must be fully undressed.
    • It may be best to undress only part of the child at a time.
    • Children can be examined without undressing them.
  15. What are danger signs?
    • Signs that the child may vomit.
    • Signs that the child is about to pass a stool.
    • Signs that the child may have a serious illness.
    • Signs that the child has started puberty.
  16. What special investigation is usually needed?
    • Urinalysis with a dipstick.
    • Chest X-ray.
    • Stool culture.
    • ESR (erythrocyte sedimentation rate).
  17. What is a problem list?
    • A list of the main points in the history.
    • A list of the important findings on physical examination.
    • A list of the patient’s problems after a full general examination.
    • A list of abnormal special investigation results.
  18. What is an action plan?
    • The order in which the examination should be performed.
    • The method of taking a present, past and social history.
    • How the special investigations should be booked or arranged.
    • The plan to address each of the patient’s identified problems.
  19. Good clinical notes:
    • Take too much time for a busy clinic.
    • Help to one to think and develop a clear idea of the child’s problems.
    • Are only important in hospitals.
    • Are only important in private practice.
  20. How should continuation notes be written?
    • Always use the SOAP system.
    • Continuation notes are not needed unless a new problem is identified.
    • Continuation notes are not required if the child always sees the same nurse or doctor who knows the problem.
    • Detailed notes of both past and present problems should be written.