Essential Clinical Skills in Pediatrics A Practical Guide to History Taking and Clinical Examination Anwar Qais Saadoon 123 Essential Clinical Skills in Pediatrics Anwar Qais Saadoon Essential Clinical Skills in Pediatrics A Practical Guide to History Taking and Clinical Examination Anwar Qais Saadoon Al-Sadr Teaching Hospital Basra Iraq ISBN 978-3-319-92425-0 ISBN 978-3-319-92426-7 (eBook) https://doi.org/10.1007/978-3-319-92426-7 Library of Congress Control Number: 2018947572 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by Springer Nature, under the registered company Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland • T o the Iraqi people who fought terrorism, sacrificing their lives for freedom and peace. Without their sublime sacrifices, I could not have written these words for the world. • T o the striver Iraqi doctors who are doing their best, working day and night to treat and save the lives of millions of people, not only in Iraq but across the globe as well. • T o the world’s best family: – My father, who taught me how to leave my imprint wherever I go. – My mother, my constant source of love and kindness. Without her warm- heartedness, I would not have been able to pass through the journey of life. – My sisters and brothers, especially Ayman, my teacher and mentor. • T o my dear relatives, in particular, my uncles Ali Saadoon and the great teacher Muhammad Abdallah. I will never forget their support. • T o all my friends, especially my soulmates, Marwan Abdulrahman and Samer Jawad. • T o the respectable teachers and wonderful students at Basra Medical College. I am proud to be a part of them. • T o those people who still live in my heart and will stay there forever. Foreword Any book that is written should solve a problem. And if the book solves that prob- lem it is worthy of publication and purchase. Such is the case of Essential Clinical Skills in Pediatrics by Dr. Anwar Qais. As a young medical student, Dr. Qais found that he needed a reference that would assist him in history taking and physical exam skills. That was the problem—no such reference existed. In subsequent years, and with additional training in pediatrics, he prepared a volume that solved that prob- lem. He has done so in a fashion that is both useful and elegant. The book, although brief, covers all the important issues in pediatrics. There are two parts: one on history-taking skills, with specific direction based on symptoms being assessed. The 31 symptoms chapters include all the pertinent topics of child healthcare, both acute and chronic complaints. The second part deals with the physi- cal exam of the child at all stages of development. Throughout the book, there are many charts, graphs, and special lists pointing out clinical tips and key points. This makes the book very readable and user-friendly. I particularly like the fact that Dr. Qais has included pertinent points of family history and social history, which are often issues of critical importance. I also appreciated the clear instructions about setting the stage for an interview and tips on interpersonal connection with the patient and family. This book is well written and very helpful. Instead of delivering information around a topic, it tells the reader what to do, what to ask, and what to examine. The reference section is complete and informative and serves as a starting point for more in-depth reading on particular diseases and conditions. Indeed, Dr. Qais saw a problem and has solved it with the production of this book. I recommend his learning guide for students, residents, and practitioners of pediatrics. Stephen Ludwig Professor of Pediatrics Children’s Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia, PA USA vii Foreword Anwar Qais Saadoon should be congratulated on the publication of his textbook, Essential Clinical Skills in Pediatrics: A Practical Guide to History Taking and Clinical Examination. The content and style are of high quality and make the infor- mation very accessible to a student or clinician who wishes to learn both the art and the science of good history taking and clinical examination. Eliciting an accurate and complete history and the performance of a thorough and reliable clinical examination remain the foundation on which both the diagnosis and the assessment of a patient’s progress are built. It is easy to forget this in these days when investigations are so readily accessible, but clinical skills will always be fundamental to medical decision making. So many times, I have seen a diagnostic problem solved by a consultation with an experienced doctor, and it is very common to see this come about when the consulted doctor returns to the basics, takes a good history, and performs a good examination. History and examination in pediatrics pose particular challenges to the clini- cian’s skills when the patient often cannot tell their own story, and when the exami- nation may be influenced by the degree of cooperation. The book has very practical tips to assist with this. This book would be very suitable for both undergraduate and postgraduate stu- dents learning pediatrics. The key points are well emphasized. I enjoyed the introductory tips on how to prepare for the consultation. The writing style, similar to a student’s lecture notes, and the liberal use of illus- trations make the content live up to the title—it is indeed both essential and practical. Mike South Professor of Pediatrics University of Melbourne Royal Children’s Hospital Murdoch Children’s Research Institute Melbourne, VIC Australia ix Foreword “To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.” —Sir William Osler In the majority of cases, clinical diagnosis can be made on the basis of a detailed history supplemented by careful physical examination of the patient. This is the clinical method, and mastery of the clinical method is the key to the art of medicine. When the patient is a child, this is more challenging, as patients can vary from a preterm newborn to a fully grown adolescent, and medical conditions vary greatly at different ages. Moreover, in the younger child, the doctor may be faced with unwillingness of the patient to be examined and yet have the requisite skills to acquire the necessary clinical information. Dr. Anwar Qais has produced here a very useful book, aptly entitled Essential Clinical Skills in Pediatrics: A Practical Guide to History Taking and Clinical Examination, as this describes exactly what the book aims to do: namely, to provide in an accessible way a concise summary of clinical pediatrics based on the practical application of the clinical method. The first part deals with history-taking skills and symptomatology in over thirty common conditions in general pediatrics. A detailed account of the specific history to be explored in each condition is followed by key points outlining essential facts underlying these specific points in the history. The second part deals with the physical examination of both the newborn and the older child. The text is very readable, being presented in a lecture-note format with highlight- ing of important facts and supplemented with marginal notes, clinical tips, boxes, and tables where appropriate. The whole text is extremely well referenced, with over 190 references provided. This small volume will be of great value both to undergraduate medical students and to postgraduate pediatric trainees working for their higher professional qualifications. Peter B. Sullivan Associate Professor of Pediatrics, Medical Sciences Division University of Oxford, Oxford University Hospital NHS Trust Oxford, UK xi Foreword There is no monopoly on wisdom with regard to what makes a good book. What works for one learner will not work for another, and so additions to the world litera- ture are incredibly welcome. This new book tackles old topics with enthusiasm. At its heart, it aims to provide guidance on how to take a good history and examination. This is no small undertaking. When we asked to summarize the required under- graduate teaching for UK medical schools, we were able to condense the curriculum into the single statement: “Be able to take a history and examination, and provide basic life support for a child and/or young person.” This book tackles the former in considerable detail. It differs from other books by offering detailed referencing for the interested reader, covering each system in depth. It is with some chagrin that I have, over the years, reflected upon the lack of examination skills that I picked up in medical school. It was not until I studied for the MRCP (UK) clinical examination that I developed a “polished routine” and as I point out to students, “the sooner you learn a proper technique, the sooner you will start to gain experience.” I would, therefore, advise readers to practice, practice, practice. This book will help you to start; it acts as a beginning. Every journey requires a beginning, and this seems like a solid place to start. Only experience and repeated exposure to examination in all ages will result in mastery of physical examination. Be courageous; take careful histories and complete thorough examinations on every child you see. Commit to a diagnosis before seeking senior review and in a few years reflect on your own journey. Will Carroll Honorary Reader in Child Health Chair of MRCPCH Theory Examinations, Keele University Stoke-on-Trent, UK xiii Preface “The best of people are those who are most beneficial to people.” —The Prophet Muhammad (PBUHHF) During my study of pediatrics in the fifth year of medical college, I encountered a problem: There was no single, reliable, and concise reference pertaining to easily and comprehensively taking the history and conducting a physical examination of a newborn or older child. Such a resource would be useful in carrying out the objec- tive structured clinical examination (OSCE). The lack of a single resource forced me to use multiple books for adequate knowledge regarding history taking and physical examination, and I had to use additional references for OSCEs. Searching multiple resources was very difficult and time-consuming. In the midst of this chal- lenge, the idea for this book arose. I have written this book to help others overcome the problems I had encountered. I have tried my best to make it as simple as possible. Moreover, I have striven to make this book comprehensive, informative, practical, and clinically oriented, justi- fying its title, Essential Clinical Skills in Pediatrics: A Practical Guide to History Taking and Clinical Examination. The book is divided into two main parts, and their order has been revised to pro- vide an intuitive structure: • Part I discusses history-taking skills and the evaluation of the common pediatric symptoms; it contains more than 30 “History Stations,” with key points, case scenarios, and many tables. • Part II gives a close look at the clinical examination of the newborn and older child. This book is addressed to undergraduate medical students preparing for clinical exams. It will also be helpful for a wide audience of postgraduate pediatric trainees working toward higher professional qualifications. Here is hoping that this book fulfills its aim of providing an essential and concise summary of clinical pediatric practice, not only in Iraq but in the rest of the world as well. Basra, Iraq Anwar Qais Saadoon xv