Case Studies 3 Flashcards
A 3y old girl is brought in to A+E following a 4 minute generalised tonic-clonic convulsion.
She has a temperature of 39.5o, a red throat and a runny nose.
whats the diagnosis ?
febrile convulsion
A 10y old boy presents with 3w of excessive drinking, secondary nocturnal enuresis, lethargy and weight loss, and 2 days of abdominal pain and vomiting.
He has cold peripheries, Temp 36.5o, RR 35, HR 140, no focal chest or abdominal findings
whats the diagnosis?
DKA
- diabetic ketoacidosis
how do you confirm diagnosis?
blood glucose
blood ketones
BGs - capillary or venous
what is the Tx of DKA?
IV insulin
IV fluids
what questions should be asked for the Hx of febrile convulsion?
duration, Fhx of seizures and epilepsy, previous Hx, any injuries, what happened before the episode, any history of infection, think about each system to try locate any infection which could be driving the fever, colour of skin, eyes, limbs – jerk, tonic, floppy
what is a DD of febrile convulsion?
rigors
epilepsy
A 4y old boy is brought in to A+E from nursery following an abrupt onset of facial swelling, tight feeling in his throat and difficulty breathing.
Examination shows he is lethargic, RR 50, HR 170, Sats 88, he has a wide spread urticarial rash and bilateral wheeze
what is the diagnosis ?
anaphylaxis
type 1 hypersensitivity
what is the management for anaphylaxis?
ABCDE
oxygen 15L/m
IM adrenaline
IV hydrocortisone
what investigations can be done to determine the allergy?
RAST test
food challenge in hospital
what is a DD for meningococcal rash?
Henoch-Schonlein purpura (HSP) is a disease involving inflammation of small blood vessels. It most commonly occurs in children
what is impetigo caused by?
staph aureus
what is the Tx for impetigo?
flucloxacillin
what does a child with parvovirus have to avoid?
pregnant woman
is a child with parvovirus generally well or unwell?
well
what is a rash on a neonate ?
erythema toxic neonatorum
what is the Tx for erythema toxic neonatorum?
nothing
what is the cause of erythema toxic neonatorum ?
not known
what is a DD for erythema toxic neonatorum ?
herpes
A 6m old boy presents with 24h of fever, poor feeding and lethargy. He has no cough/ runny nose and has not passed urine or stools for 24h
Examination- T 41.5o, HR 185, RR 60, CRT 6s, cool peripheries, drowsy, irritable on handling.
what is the diagnosis ?
meningitis with septicaemia
what are some DD for a cause of fever in a 9month infant?
URTI
LRTI
UTI
Gastroenteritis
what are some investigations to be done for a generally unwell child ?
FBC
BG
Lactate
what is the management done for a generally unwell child ?
HFo2
IV access
urgent senior review
what is a flat head called?
brachyencephaly
what is a assymetrical head?
plagiocephaly
