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Year 3 Paediatrics > 102. Cases 2 > Flashcards

102. Cases 2 Flashcards

1
Q

Child with strong smelling urine, vomiting, tachycardia. No chest abdomen or throat findings. Differentials?

A

UTI
URTI
Abdominal causation

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2
Q

Child with strong smelling urine, vomiting, tachycardia. No chest abdomen or throat findings. Investigations ?

A

Clean catch/mid stream recommended
Pads and bags- not great false negatives
Suprapubic catheters

Don’t wait for sample if someone is unwell!

FBC,CRP, CXR, throat swab

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3
Q

Child with strong smelling urine, vomiting, tachycardia. No chest abdomen or throat findings. Treatment ?

A

Yes

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4
Q

Child with strong smelling urine, vomiting, tachycardia. No chest abdomen or throat findings. Follow up investigations?

A

Look for VUR
Renal USS looks at anatomy
DMSA (looks for scars)
MCUG (looks for reflex is DMSA positive)

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5
Q

3 year old presents with 5 days of vomiting and bloody diarrhoea, Tolerating oral fluid and visited petting zoo. No skin changes, abdo discomfort. Differentials?

A

E.coli 0157 infection
Potential HUS

Can also be campylobacter, salmonella, shigella, yersinia

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6
Q

3 year old presents with 5 days of vomiting and bloody diarrhoea, Tolerating oral fluid and visited petting zoo. No skin changes, abdo discomfort. How do you assess hydration status?

A 
Turgour
Temperature
Eyes sunken and tears
Sunken fontanelle
Drowsy
Oliguria
Tachycardia morning tachypnoeac

Look at pictures to confirm

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7
Q

3 year old presents with 5 days of vomiting and bloody diarrhoea, Tolerating oral fluid and visited petting zoo. No skin changes, abdo discomfort. Investigations?

A

3 stool samples and one stool virology
U&E’s, FBC, blood film
LDH- red cell fragmentation

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8
Q

3 year old presents with 5 days of vomiting and bloody diarrhoea, Tolerating oral fluid and visited petting zoo. No skin changes, abdo discomfort. Management ?

A 
No antibiotics!
Low threshold for IV fluids
Maintain hydration status
Monitor bloods for HUS 
Look into other family members infected
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9
Q

A child presents with bruising and pale. Differentials

A

HUS
Leukaemia
Sepsis

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10
Q

9 year old boy, parents concerned he wets the bed most nights (enuresis) primary- always been wet, secondary- been wet and comes back. No fever and abdominal/spinal/neuro exam is normal. differentials?

A

Diabetes

Childhood trauma

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11
Q

9 year old boy, parents concerned he wets the bed most nights (enuresis) primary- always been wet, secondary- been wet and comes back. No fever and abdominal/spinal/neuro exam is normal. History ?

A 
Do they wet during the day
Do they drink a lot during the day
Urgency 
Frequency
Constipation/stool pattern
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12
Q

9 year old boy, parents concerned he wets the bed most nights (enuresis) primary- always been wet, secondary- been wet and comes back. No fever and abdominal/spinal/neuro exam is normal. Investigations?

A

Urinalysis
Fluid chart
Blood glucose

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13
Q

9 year old boy, parents concerned he wets the bed most nights (enuresis) primary- always been wet, secondary- been wet and comes back. No fever and abdominal/spinal/neuro exam is normal. Management?

A

Desmospressen- ADH
Decrease night fluids
Pads and alarms
Consider desmopressin

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14
Q

3 month old bottle fed baby, loose stools, vomits each day. Health visitors want to change milk. Diagnosis

A

Cows milk protein allergy

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15
Q

3 month old bottle fed baby, loose stools, vomits each day. Health visitors want to change milk. History

A 
Vomit history- colour, timing, how much feed they get
Breathless
Cough
UTI
NEURO
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16
Q

3 month old bottle fed baby, loose stools, vomits each day. Health visitors want to change milk. Investigations

A

None for cows milk allergy
If poor weight gain check FBC and thyroid for anemia and hyperthyroidism
Unless vomiting history suggests otherwise

17
Q

3 month old bottle fed baby, loose stools, vomits each day. Health visitors want to change milk. Management

A

Top to examination
Nutramigen (hydrolysed milk)
Milk free weaning advice
May need thickeners/acid suppression to deal with reflux

18
Q

4 week old otherwise healthy baby. Good weight gain, breast fed, present with streaks of fresh blood in stool for last 7 days, no fever of vomits.
Dad asthma mum has IBS
General/abdo exam normal. Differential?

A

Crohns- too young
HUS- too young breast fed, not diarrhoea
Tear- too young
Infection/ constipation

Most likely cows milk intolerance

19
Q

4 week old otherwise healthy baby. Good weight gain, breast fed, present with streaks of fresh blood in stool for last 7 days, no fever of vomits.
Dad asthma mum has IBS
General/abdo exam normal. History questions ?

A

Family- food intolerance, atopy
Change in stool
Clarify weight gain
Straining/pain vomiting

20
Q

4 week old otherwise healthy baby. Good weight gain, breast fed, present with streaks of fresh blood in stool for last 7 days, no fever of vomits.
Dad asthma mum has IBS
General/abdo exam normal. Management ?

A 
Change mums diet as they’re breast fed
Start with cakes a biscuits- protein more likely to be denatured, low protein (UK milk ladder)
Make sure mum is taking enough calcium 
Most of them overcome it eventually
Stool culture
21
Q

What are the two types of food allergy?

A

IgE- rash, wheeze, anaphylacxis. Skin tests might help

Non IgE (more common e.g. milk allergy) takes days to come on, days to clear, no tests. Subtle. Only treatment is elimination

22
Q

How do you treat eczema?

A

Topical steroids

If that doesn’t work try hydrolysed milk diet for 4 weeks

23
Q

A 3 year old baby is brought to A&E with a 4 minute generalised tonic-clonic convulsions
She has a temperature of 39.5, a red throat and a runny nose
Differential

A

Rigor- awake, fine movement (leaning forward)
Febrile convulsion- not awake, rhythmic jerking (flat and extending). Tonic clonic
Epilepsy

24
Q

4 week old otherwise healthy baby. Good weight gain, breast fed, present with streaks of fresh blood in stool for last 7 days, no fever of vomits.
Dad asthma mum has IBS
General/abdo exam normal. What would you ask in the history?

A 
One half or both half’s- symmetrical- febrile convulsion
Who witnessed
Eyes rolling, fixed, vacant
Colour blue pale red?
Time to become back to normal
Family history 
Post ictal phase? Not in febrile convulsion 
Developmental delays?
25
Q

4 week old otherwise healthy baby. Good weight gain, breast fed, present with streaks of fresh blood in stool for last 7 days, no fever of vomits.
Dad asthma mum has IBS
General/abdo exam normal. Management ?

A

Bacterial and viral throat swabs
Benzodiazepines (seizures over 10 minutes) (medazalan)
Blood glucose of fitting for a prolonged time
Most just need observation

26
Q

What is plagiocephaly?

A

Squint head- Latin

27
Q

What is brachycephaly?

A

Flat head

28
Q

What do you do with babies with funny heads?

A

Measure and plot the head
Check and reassure over development (smiling, visual tracking)
Make sure you don’t miss craniosynestosis. Heads are fixed so are more asymmetric over time
Encourage tummy time to fix back of head, reposition toys in cots so in different positions

29
Q

10y old boy presents with 3w of excessive drinking, secondary nocturnal enuresis, lethargy and weight loss, and 2 days of abdominal pain and vomiting. Cold peripheries, tachyopeneac. Differentials?

A

Diabetic ketoacidosis

30
Q

10y old boy presents with 3w of excessive drinking, secondary nocturnal enuresis, lethargy and weight loss, and 2 days of abdominal pain and vomiting. Investigations ?

A

IV access

D (glucose)
Ketones (bloods)
A capillary blood gas

31
Q

10y old boy presents with 3w of excessive drinking, secondary nocturnal enuresis, lethargy and weight loss, and 2 days of abdominal pain and vomiting. Management?

A 
IV insulin based on weight 
Additional fluids with potassium 
Subcut insulin thereafter 
Avoid bicarbonate
Monitor electrolytes and acid base balance
32
Q

A 4 month old girl is brought to A+E with a 3 day history of being unsettled and not feeding well. There is no fever or other systemic features No cough, D+V, rash, colour change

Examination shows she has reduced movements of her right leg but is otherwise normal differentials?

A

Yes

33
Q

A 4 month old girl is brought to A+E with a 3 day history of being unsettled and not feeding well. There is no fever or other systemic features No cough, D+V, rash, colour change

Examination shows she has reduced movements of her right leg but is otherwise normal differentials? Investigations

A

USS

X-ray

34
Q

What causes a spiral fracture of the femur

A

Rotational force of the femur

35
Q

A 4 month old girl is brought to A+E with a 3 day history of being unsettled and not feeding well. There is no fever or other systemic features No cough, D+V, rash, colour change

Examination shows she has reduced movements of her right leg but is otherwise normal differentials. Child has a broken femur. What else do you want to ask?

A

How did it happen
When did it happen
Rickets

36
Q

What is the most common injury that young siblings inflict on each other?

A

Bites

37
Q

A 4 month old girl is brought to A+E with a 3 day history of being unsettled and not feeding well. There is no fever or other systemic features No cough, D+V, rash, colour change

Examination shows she has reduced movements of her right leg but is otherwise normal differentials? She has a broken femur. Management

A 
Documentation of history
Full examination
Analgesia
Peads and ortho
Refer to social services

Skeletal survey
CR head, bone blood,retinal scam
Fix the cast

38
Q

Where do children likely bruise?

A

Bony bits, knees and shins

Year 3 Paediatrics (42 decks)

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