103. Cases 3 Flashcards
8 week old baby boy presents for routine exam
He has murmur
What features should you ask about?
Cyanosis (lack of pink) FH of heart disease (mum) Preterm Feeding Infections, alcohol,phenytoin Weight gain? Breathlessness
8 week old baby boy presents for routine exam
He has murmur
What features should you look for
Peripheral pulses Upper limb pulses Hepatomegaly Dysmorphic features Tachycardia tachypnoeac
8 week old baby boy presents for routine exam
He has murmur
What investigations should you do?
Refer to peads ECHO Watch and wait Sats BP upper and lower ECG
Commones features of murmurs in children?
Vibratory Soft Systolic Asymptomatic Left sternal edge
12 hour baby girl on routine post delivery exam, cyanotic, has peripheral pulses
Differential
Transposition of the great arteries
12 hour baby girl on routine post delivery exam, cyanotic, has peripheral pulses
Differential
Sats- upper and lower limb Admit to neonatal Chest x-ray ECHO 100% oxygen (check it’s heart) Ionotropes, ventilations, Prostaglandins to preserve duct
What are the 5 T’s?
Truncus arteriosus Transposition of great arteries Tricuspid atresia Tetralogy of fallout TAPVD
How do you check a cyanosed baby at night?
TURN A LIGHT ON
What are the common genetic conditions and there associated heart defects?
Downs- atrio ventricular septal defects
Turners- coarctation of the aorta
Williams- ppulmonary stenosis
Noonans- aortic stenosis
What are the most common congenital heart defects
Ventricular septal defect- no cyanosis
Patent ductus arteriosus- prematurity
Atrial septal defect- late presentation
Tetralogy of fallot- cyanotic spells
Pulmonary stenosis- increased right sided heart pressure
Coarctation of the aorta- once duct closes they go to fuck
Aortic stenosis- fainting and syncope
Transposition of the great arteries- cyanosis at birth
2 year old girl 2 days of runny nose, cough, no fever, doing well
Blood results- FBC, Hb 5.3, MCV 57, PLT 300, WBC 6.0
What’s the diagnosis?
Iron deficiency aneamia or beta thalassaemia
2 year old girl 2 days of runny nose, cough, no fever, doing well
Blood results- FBC, Hb 5.3, MCV 57, PLT 300, WBC 6.0
What’s the investigations?
Normal ferritin, blood film
2 year old girl 2 days of runny nose, cough, no fever, doing well
Blood results- FBC, Hb 5.3, MCV 57, PLT 300, WBC 6.0
What’s the treatment?
Increases dietary iron
Check and reduce milk consumption
Dietician referral
Oral iron
What are the different types of anaemia and the tests you can do?
Microcytic hypochromic- ferritin levels
Normocytic normochromic- reticulocytes
Marcocytic- B12/folate
Wee boy gets lethargy, looking pale, recurring fever
Examination shows multiple bruises on the legs back and chest,
Purpula, petichae, Lymph nodes enlarged and hepatocytes-splenomegaly
Diagnose and differentials?
Acute leukaemia
Septicaemia
Haemolytic ureamic syndrome
Wee boy gets lethargy, looking pale, recurring fever
Examination shows multiple bruises on the legs back and chest,
Purpula, petichae, Lymph nodes enlarged and hepatocytes-splenomegaly
Investigations and management
FBC, blood films,
Diferntrtials of bruises, purpura and petechia?
HSP
Sepsis
Trauma
What causes thrombocytopenia
ITP
Leukemia
Disseminated intravascualr coagulation
5 year old girl presents with a 24 hour history of reluctance to walk
She has a cold three days ago. No swelling, no skin changes, full range, movement in hips and knees
Diagnosis and differentials?
Osteosarcoma JIA, tendon synovitis, septic athritis, osteomyelitis SUFE, perthes Transient synovitis Trauma
5 year old girl presents with a 24 hour history of reluctance to walk
She has a cold three days ago. No swelling, no skin changes, full range, movement in hips and knees
Assuming transient synovitis, what’s the management?
Watch and wait
USS if doesn’t settle
Change diagnosis if doesn’t settle
Blood cultures, X- rays if gets worse
Where can you find extra questions?
Learning guide- defo have a look at before exams
Last years case study powerpoints
What drug would you give to children with UTI?
Upper tract- co amoixiclav/IV cephlaspron
Lower tract- trimethoprim
3 week old baby boy, born at 29 weeks. On CPAP
Developed a rapid rise in his oxygen requirement and RR
Reduced air examination on the left
Differentials?
Pneumothorax
sepsis
3 week old baby boy, born at 29 weeks. On CPAP
Developed a rapid rise in his oxygen requirement and RR
Reduced air examination on the left
What signs would you see
Trans illumination of the chest (use a cold light on skin) Tracheal deviation Mediastinal shift (on x-ray) Low sats Heart sod shifter Tachycardia/bradychardia
3 week old baby boy, born at 29 weeks. On CPAP
Developed a rapid rise in his oxygen requirement and RR
Reduced air examination on the left
What action would you take?
Call for help
ABCD
Intubate
Aspirate air 2nd intercostal space mid clavicular line
Chest drain 4th intercostal space mid axillary line
26 day old baby noted to be jaundiced but the health visitor
Referred to peads
What features should you ask about?
Bowel movements- pale stool, bright urine is bad, also ask urine smells
Vomit- biliary vomiting
Breast feeding
Putting on weight? How much
First noticed jaundice
Siblings with jaundice
Gestation they were born at
Maternal infections
Feeding and lethargy
Phototherapy
26 day old baby noted to be jaundiced but the health visitor
Referred to peads
What features should you look for in examination?
Look in eyes
Skin pigmentation
Splenomegaly, hepatomegaly
Growth measurements
Look for cephaloheamatology
Anaemic signs- pallor, breathless feeding- ask revolta
26 day old baby noted to be jaundiced but the health visitor
Referred to peads
Differentials?
Physiological jaundice (unconjugated)
Breast feeding jaundice (unconjugated)
Infection , hemaolytic anemia (unconjugated)
Biliary atresia Neonatal hepatitis (congenital infections/ metabolic)
26 day old baby noted to be jaundiced but the health visitor
Referred to peads
Investigations
Conjugated vs unconjugated
Full blood count (heamolysing)
Blood film
Liver function
ALL OVER 3 WEEKS NEED INVESTIGATED
Urine dipstick and culture
4 year old boy brought in to A+E with facial swelling, tight throat, difficulty breathing
Lethargic RR50, HR 170, sats 88. Uterical rash and Bilateral wheeze
Diagnosis?
Anaphylaxis
Induced by nuts, latex or
4 year old boy brought in to A+E with facial swelling, tight throat, difficulty breathing
Lethargic RR50, HR 170, sats 88. Uterical rash and Bilateral wheeze
Management
ABCDE Adrenaline (out of hospital epipen, in hospitals premade pack) Oxygen 15l/m IV access and fluid resuscitation Antihistamines and hydrocortisone Salbutamol
4 year old boy brought in to A+E with facial swelling, tight throat, difficulty breathing
Lethargic RR50, HR 170, sats 88. Uterical rash and Bilateral wheeze
Advice on discharge?
Previous reactions?
Dietary recall?
Nuts before? What nuts?
Epipen and antihistamines at all time
Dietician
4 year old boy brought in to A+E with facial swelling, tight throat, difficulty breathing
Lethargic RR50, HR 170, sats 88. Uterical rash and Bilateral wheeze
Follow up investigations?
GOOD HISTORY AND EXAM BEST WAY
Allergy referral
skin prick
IgA blood test
Summarise impetigo
Staph aureus honeycomb rash
Skin swab
Flucoxacillin oral if satellite lesions
Summarise herpes?
PCR swab needed Aciclovir ? IV fluids, Analgesia on the mouth (diflam spray) Prescribe ice cream
Summarise chicken pox
Caused be varicella zoster
No investigations or treatment
Definitely don’t give iboprufen
Discuss slapped cheek virus
Full body rash Tell nursery and school Safety netting (Bone marrow infiltration) Takes ages to go away Avoid pregnant women Parvovirus B19 Supportive care, antipyretics
Discuss periorbital infection
Staph aureus causing
IV antibiotics
If they can open their eye you can trial oral
Discuss erythema toxicum?
Nobody knows what causes it
No treatment unless crusts- check staph and herpes
Reassure parents
6 month, 24 year old fever
Poor feeding and lethargy
No cough, runny nose
Not passes any urine in stools
High temp, high heart rate, high rest rate, drowsy
Diagnosis?
Sepsis!
What is are diffenial causes for fever in an infant
URTI LRTI gastroenteritis bug Meningitis Septicaemia Septic athritis, osteoarthritis Kawasaki and non infective disease
How do you investigate and manage sepsis?
Weigh nappies to assess output
Give fluid resuscitation (crystalloid). 20ml per kilo
Help
Cefitraxin
Monitor heart rate and blood pressure
Review
FBC, lactate, glucose, CRP, culture
High flow oxygen
