Case Studies 2 Flashcards
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 ?
gastroenteritis
what are the causes of GE?
Campylobacter salmonella E coil 0157 shigella IBD
what are the potential complications of GE?
HUS
how do you assess hydration in children ?
capillary refill pulse skin turgor skin colour skin temp mucous membranes HR BP alertness
what investigations should be done for GE?
stool cultures blood film - check for HUS FBC U&Es Hb LDH - gets released during haemolysis
what is the management of GE?
fluid management
monitor fluid in and out
monitor bloods for HUS
what is the main organism to cause gastroenteritis ?
E coli 0157
what is a complication of E coli 0157?
HUS (haemolytic ureamic syndrome)
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?
primary nocturnal enuresis
what investigations should be done for noctural enuresis ?
urine dip stick
what investigations should be done for UTI in an infant?
Urine dipstix, microscopy and culture
how does an UTI present in neonates ?
fever, vomiting
lethargy
irritability
how does an UTI present in children?
fever
frequency
dysuria
what are the two main concerns of children having UTIs?
VUR (reflux)
renal scarring
what isotope scan is used for renal scarring?
DMSA
what is the triad of HUS?
microangiopathic haemolytic anaemia
thrombocytopenia
acute renal failure
what does HUS stand for?
haemolytic uraemic syndrome
what is a complication of HUS?
ESRF (end stage renal failure)
does primary nocturnal enuresis affect boys or girls more?
boys
what is the management of primary nocturnal enuresis ?
decrease night fluids
increase daytime fluids
pads
what are the common features of an innocent murmur?
vibratory soft systolic localised varies with activity, position and respiration
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?
cyanotic heart disease
- transposition of great arteries
- pulmonary atresia
- truncus arteriosus
what heart condition is associated with downs ?
AVSD
what heart condition is associated with turners ?
coarctation
what heart condition is associated with noonans ?
pulmonary stenosis
what heart condition is associated with williams ?
supravalvular aortic stenosis
state some risk factors of congenital heart disease?
maternal antenatal health (DM, SLE)
maternal substances (alcohol, lithium)
TORCH (infections)
what are the 8 most common heart lesions?
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
what are the signs of a pneumothorax?
Reduced air entry on left (??Percussion), Low sats
Tachypnoea
Heart sounds shifted to right
Altered perfusion (Tachycardia/ ?Bradycardia)
Chest Transillumination
what questions should be asked for a 26 day old baby with jaundice?
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
state some cause of unconjugated jaundice?
Physiological jaundice Breast milk jaundice Infection (urinary) Hypothyroidism Haemolytic anaemia
state some cause of conjugated jaundice?
bile duct obstruction (biliary atresia)
neonatal hepatitis
what investigations should be done for a baby with jaundice?
FBC blood film coombs split bilirubin LFTs TFTs (thyroid function tests)
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?
Transient synovitis (Irritable hip)
Reactive arthritis
Trauma
what is the treatment for transient synovitis?
self limiting illness
what is the treatment of iron deficiency in children?
Increase dietary iron (red meat, green veg)
Check (and reduce) milk consumption
Dietician referral
Oral iron supplementation (~3m)
what are the three general causes of anaemia in children?
impaired red cell production
increased haemolysis
blood loss
state some causes of increased haemolysis ?
hereditary spherocytosis G6PD deficiency thalassaemias sickle cell auto immune haemolytic anaemias
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 ?
ALL (acute lymphoid leukaemia)
what investigations should be done for suspected ALL?
FBC and Film to confirm
Coag/ U+E/ LFT/ CRP
state three causes of thrombocytopenia petechia?
Idiopathic thrombocytopenic purpura (ITP)
Leukaemia
Disseminated intravascular coagulation (DIC)
