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Y3 Paediatrics > Case Studies 2 > Flashcards

Case Studies 2 Flashcards

1
Q

A 3y old boy presents with 5 days of vomiting and bloody diarrhoea. He is tolerating oral fluids and recently visited a petting zoo
Examination showed no fever, HR 100, RR 25, no skin changes and mild general abdo discomfort
what is the diagnosis ?

A

gastroenteritis

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2
Q

what are the causes of GE?

A 
Campylobacter 
salmonella
E coil 0157 
shigella 
IBD
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3
Q

what are the potential complications of GE?

A

HUS

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4
Q

how do you assess hydration in children ?

A 
capillary refill
pulse 
skin turgor 
skin colour 
skin temp 
mucous membranes 
HR 
BP 
alertness
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5
Q

what investigations should be done for GE?

A 
stool cultures 
blood film - check for HUS
FBC 
U&Es
Hb 
LDH - gets released during haemolysis
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6
Q

what is the management of GE?

A

fluid management
monitor fluid in and out
monitor bloods for HUS

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7
Q

what is the main organism to cause gastroenteritis ?

A

E coli 0157

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8
Q

what is a complication of E coli 0157?

A

HUS (haemolytic ureamic syndrome)

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9
Q

A 9y old boy is brought is because parents are concerned that he still wets the bed most nights.
He has no fever and abdominal/ spinal/ neuro examination is normal.
what is the diagnosis?

A

primary nocturnal enuresis

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10
Q

what investigations should be done for noctural enuresis ?

A

urine dip stick

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11
Q

what investigations should be done for UTI in an infant?

A

Urine dipstix, microscopy and culture

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12
Q

how does an UTI present in neonates ?

A

fever, vomiting
lethargy
irritability

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13
Q

how does an UTI present in children?

A

fever
frequency
dysuria

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14
Q

what are the two main concerns of children having UTIs?

A

VUR (reflux)

renal scarring

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15
Q

what isotope scan is used for renal scarring?

A

DMSA

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16
Q

what is the triad of HUS?

A

microangiopathic haemolytic anaemia
thrombocytopenia
acute renal failure

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17
Q

what does HUS stand for?

A

haemolytic uraemic syndrome

18
Q

what is a complication of HUS?

A

ESRF (end stage renal failure)

19
Q

does primary nocturnal enuresis affect boys or girls more?

A

boys

20
Q

what is the management of primary nocturnal enuresis ?

A

decrease night fluids
increase daytime fluids
pads

21
Q

what are the common features of an innocent murmur?

A 
vibratory 
soft 
systolic 
localised 
varies with activity, position and respiration
22
Q

A 12h old baby girl is noted on routine post delivery examination to be blue (face, tongue and limbs). Peripheral pulses are present. A loud systolic murmur is present
what is the DD?

A

cyanotic heart disease

  • transposition of great arteries
  • pulmonary atresia
  • truncus arteriosus
23
Q

what heart condition is associated with downs ?

A

AVSD

24
Q

what heart condition is associated with turners ?

A

coarctation

25
Q

what heart condition is associated with noonans ?

A

pulmonary stenosis

26
Q

what heart condition is associated with williams ?

A

supravalvular aortic stenosis

27
Q

state some risk factors of congenital heart disease?

A

maternal antenatal health (DM, SLE)
maternal substances (alcohol, lithium)
TORCH (infections)

28
Q

what are the 8 most common heart lesions?

A 
Ventricular Septal Defect 			(VSD)
Patent Ductus Arteriosus      		(PDA)
Atrial Septal Defect              		(ASD)
Tetralogy of Fallot
Pulmonary Stenosis
Coarctation of the Aorta
Aortic Stenosis
Transposition of the Great Arteries
29
Q

what are the signs of a pneumothorax?

A

Reduced air entry on left (??Percussion), Low sats
Tachypnoea
Heart sounds shifted to right
Altered perfusion (Tachycardia/ ?Bradycardia)
Chest Transillumination

30
Q

what questions should be asked for a 26 day old baby with jaundice?

A 
Full birth history (gestation/ delivery/ resus/ wgt)
Age of onset/ phototherapy at birth
Mode of feeding/ Weight gain
Colour of urine/ stools
Siblings with jaundice
31
Q

state some cause of unconjugated jaundice?

A 
Physiological jaundice
Breast milk jaundice
Infection (urinary)
Hypothyroidism
Haemolytic anaemia
32
Q

state some cause of conjugated jaundice?

A

bile duct obstruction (biliary atresia)

neonatal hepatitis

33
Q

what investigations should be done for a baby with jaundice?

A 
FBC
blood film 
coombs
split bilirubin 
LFTs
TFTs (thyroid function tests)
34
Q

A 5y old girl presents with a 24h history of reluctance to walk and difficulty weight bearing. She had a “cold” 3 days ago.
Examination shows Temp 37.50, no swellings, normal perfusion, no skin changes, full range of movement in hips and knees. Not weight bearing
what is the DD?

A

Transient synovitis (Irritable hip)
Reactive arthritis
Trauma

35
Q

what is the treatment for transient synovitis?

A

self limiting illness

36
Q

what is the treatment of iron deficiency in children?

A

Increase dietary iron (red meat, green veg)
Check (and reduce) milk consumption
Dietician referral
Oral iron supplementation (~3m)

37
Q

what are the three general causes of anaemia in children?

A

impaired red cell production
increased haemolysis
blood loss

38
Q

state some causes of increased haemolysis ?

A 
hereditary spherocytosis 
G6PD deficiency 
thalassaemias
sickle cell 
auto immune haemolytic anaemias
39
Q

A 3y old boy presents with 4 weeks of lethargy, looking pale and recurring fevers.
Examination showed multiple bruises on the legs back and chest, enlarged cervical/ inguinal lymph nodes and hepato-splenomegaly.

what is the diagnosis ?

A

ALL (acute lymphoid leukaemia)

40
Q

what investigations should be done for suspected ALL?

A

FBC and Film to confirm

Coag/ U+E/ LFT/ CRP

41
Q

state three causes of thrombocytopenia petechia?

A

Idiopathic thrombocytopenic purpura (ITP)
Leukaemia
Disseminated intravascular coagulation (DIC)

Y3 Paediatrics (20 decks)

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