Common Paediatric Problems Flashcards
top 10 reasons for GP referral
growth concerns UTI constipation abdominal pain headaches funny turns heart murmur food allergies and intolerances minor abnormalities asthma
causes of short stature
familial
if obese consider endocrine cause (red flag)
UTI red flags
younger frequent non E.coli FH of renal disease poor growth/general health poor flow voiding problems/constipation spinal abnormality raised BP renal tract abnormalities abdominal mass
management of constipation
laxatives
attention to diet
toileting advice
red flags in constipation
no passage of meconium more than 24 hours after birth
abdominal pain diagnoses not to miss
Coeliac’s
IBD
malrotation
intermittent volvulus
red flags in abdominal pain
weight loss deceleration in linear growth GI blood loss significant vomiting (especially if bilious) chronic diarrhoea unexplained fever FH of IBD mouth ulcers perianal disease
red flags for headache
worse on waking/coughing/ bending associated vomiting visual change gait disturbance cranial nerve palsy
examples of funny turns causes
seizure
breath-holding
reflex anoxic seizure
night terror
red flags for cardiac syncope
known congenital HD syncope during exercise/ when supine FH of sudden death prolonged QT or hypertrophic cardiomyopathy syncope preceded by palpitations heart murmur
features of an innocent heart murmur
systolic
low intensity
2nd left ICS
medial to apex or beneath clavicle (continuous venous hum that disappears when supine)
red flags for heart murmur
diastolic loud harsh thrill radiates other symptoms
what are examples of minor abnormalities
abnormal growth
abnormal development
when is asthma more likely in a child?
atopic disease FH widespread wheeze worse at night/early morning exercise and other triggers
what are four surgical problems in neonates?
meconium ileus
jejunal atresia
inguinal hernia
malrotation with volvulus
what causes meconium ileus?
intraluminal obstruction
presentation of meconium ileus
vomiting
no opening of bowels for more than 24 hours after birth
doughy abdomen
diagnosis of meconium ileus
XR enema contrast shows soap bubble sign
narrow bowel that has never been used
common cause of meconium ileus
CF
what is jejunal atresia?
dead end
presentation of jejunal atresia
vomiting
no stool passage
bowel stretching
diagnosis of jejunal atresia
XR shows enlarged bowel (compare with size of vertebrae)
what is an inguinal hernia
outer wall obstruction
presentation of inguinal hernia
loss of groin creases on affected side
risks perforation
diagnosis of inguinal hernia
clinical
XR shows laddering
is malrotation with volvulus an emergency?
yes
presentation of malrotation with volvulus
mossy green vomit (bile) within first year of life
diagnosis of malrotation with volvulus
upper GI XR with contrast shows bowel not in correct place
management of malrotation with volvulus
early surgery required
what is malrotation with volvulus
mesentery twists
what are examples of surgical problems in childhood?
pyloric stenosis intussusception peritonitis acute scrotum scrotal/ reproduction organ problems
what is pyloric stenosis
thickening of the stomach wall that prevents passage of food
presentation of pyloric stenosis
projectile milky vomit
6 weeks of age
bumps on abdomen with waves of peristalsis
diagnosis of pyloric stenosis
USS
what is there a risk of in pyloric stenosis?
metabolic alkalosis due to acid loss
management of pyloric stenosis
surgery
fluids
what is intussusception?
bit of bowel telescopes in on itself
presentation of intussusception
6 month old
abdominal pain in cycles
poor feeding
vomit with food/green colour
little stool passage (often red currant jelly-like blood)
bumps on abdomen at mid-gut region that on palpation feel like a sausage
diagnosis of intussusception
USS (target lesion and pseudo-kidney)
management of intussusception
surgery or in radiology (blow air up anal canal)
what is peritonitis?
inflammation of the peritoneum
presentation of peritonitis
abdominal pain worsened by jumping
temperature
diagnosis of peritonitis
clinical
USS shows thickened wall
management of peritonitis
surgery to remove
three causes of acute scrotum
- testicular torsion
- twisting of hydatid of Morgagni
- epididymis infection
how long do you have in testicular torsion?
4 hours due to risk of testicular death
presentation of twisting of hydatid of Morgagni
blue dot
pain
cause of twisting of hydatid of Morgagni
ovarian duct
management of epididymis infection
antibiotics
presentation of idiopathic scrotal oedema
redness in scrotum that can extend to groin
bit achy
tissue can look waterlogged
does idiopathic scrotal oedema require surgery?
no
what is BXO?
balanitis xerotica obliterans
white scar over end of the penis that can extend into the urethra
management of BXO
circumcision
management of paraphimosis
non-surgical
squeeze out oedema
what is hypospadias?
urethra is not coming out of the tip of the penis, can be anywhere along shaft
congenital abnormality
management of hypospadias
elective surgery
what is patent processus vaginalis?
the canal where the testes descended remains open
presentation of patent processus vaginalis
fluid accumulation
swollen scrotum at the end of the day, but not in the morning
blue-ish
not sore
management of patent processus vaginalis
gone by aged 4, if not do surgery
common respiratory problems in children
- bronchiolitis
- croup
- asthma
- pneumonia
causes of bronchiolitis
RSV
adenovirus
rhinovirus
presentation of bronchiolitis
cough
crackles
poor feeding/growth
secretions
management of bronchiolitis
oxygen
NG tube
CPAP
what is croup?
larynotracheobronchitis
presentation of croup
stridor
chest wall collapses
snotty
XR of croup
narrowed trachea
hypopharynx distension
management of croup
steroids
associations with asthma
atopic eczema
hay-fever
food allergies
presentation of asthma
wheeze (bronchiolitis in early life can cause episodic wheeze)
what age can spirometry be done?
7 so give inhalers if earlier presentation
examination sign for asthma
Harrison’s sulcus
cause of pneumonia in neonates
group B strep
management of pneumonia
antibiotics
CNS problems in childhood
meningitis
encephalitis
what is febrile seizure?
fits/faints due to a reaction to temperature
grow out of it by 6
what to do miss cardiacally in kids?
long QT
GI/urogenital problems
gastroenteritis
GI obstruciton (pyloric stenosis)
appendicitis
testicular torsion
CVS problems in childhood
CHD
arrhythmias (WPW)
bacterial endocarditis
