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Paeds OSCE > Common Presentations and Differentials > Flashcards

Common Presentations and Differentials Flashcards

1
Q

What are the differentials in a failure to thrive history?

A 
Pyloric Stenosis
Coeliac Disease
IBD
Eating Disorder
GORD
Cystic Fibrosis
Cows milk protein allergy
Lactose Intolerance
Neglect
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2
Q

What systems reviews do you ask in a failure to thrive history?

A

General

GI

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3
Q

What are the key questions to ask in a failure to thrive history?

A 
Detailed dietary and feeding history.
Hunger?
Activity levels, energy levels and amount of exercise? Any questions regarding eating disorders?
Number of wet/dirty nappies or times goes to the toilet? GI symptoms?
ASK TO SEE GROWTH CHARTS
PMH
Happy?
Behaviour?
Parent's weight and health
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4
Q

What are the differentials in a weight gain history?

A 
Obesity
Familial Obesity
Cushing's Syndrome
Hypothyroidism
PCOS
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5
Q

What are the differentials in a childhood bruising history?

A 
NAI
AI
ITP
HSP
Meningococcal Septicaemia
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6
Q

What are the differentials in a global developmental delay history?

A 
Neglect/abuse
Chromosomal abnormality
Maternal use of drugs in utero
TORCH infection in utero
Prematurity
Hypoxic Brain injury
Hypoglycaemia
Intraventricular haemorrhage
Meningitis/Encephalitis
Head injury or hypoxic episode
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7
Q

What are the differentials in a delayed walking history?

A

Duchenne’s Muscular Dystrophy
Cerebral Palsy
Developmental Dysplasia of the Hip

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8
Q

What are the differentials in a delayed speech history?

A

Deafness
Neglect/abuse
Cleft palate
Familial

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9
Q

What are the differentials in a early puberty history?

A 
Adrenal tumour/hyperplasia
Ovarian/testicular tumour
Familial
Intracranial tumour
CNS problem e.g. hydrocephalus
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10
Q

What are the differentials in a delayed puberty history?

A 
Constitutional
Hypothyroidism
Systemic disease
Turner's - 45 XO
Klinefelter's - 47 XXY
PCOS
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11
Q

What are the differentials in a fits/faints history?

A 
NEAD
Epilepsy
Breath holding 
Reflex Anoxic Syndrome
Febrile Convulsions
Vasovagal
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12
Q

What are the main causes of tachycardia in children?

A 
Upset
Stranger fear
Pyrexia
Pain
SVT (>220)
Increased work (similar to exercise. I.e. using accessory muscles to breathe)
Cardiac failure
Hyperthyroid
Shock secondary to sepsis
Shock secondary to injury (accidental or non accidental)
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13
Q

What are the main causes of tachypnoea in children?

A

Congenital abnormality i.e diaphragmatic hernia
Shock secondary to injury, third space losses or sepsis
Primary respiratory illness i.e. Bronchiolitis
DKA
Cardiac Failure
Compensation for a metabolic problem

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14
Q

What could be the cause of a neonate who is more sleepy than usual?

A

Hypoglycaemia
Exhausted (due to work of breathing)
Encephalopathy secondary to infection
Hypoxia
Neurological problem following head injury
Encephalopathy secondary to a metabolic condition i.e. high ammonia

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15
Q

What are the key things looked at in the traffic light system for recognising the seriously unwell child?

A

Colour
Activity
Respiratory - rate, signs of distress, sounds, sats
Circulation and hydration - CRT, HR, hydration status, feeding, urine output
Temperature
Presence of rash
Focal neurological signs

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16
Q

What are the signs of dehydration in a child?

A 
Dry mucus membranes
Sunken fontanelle
Reduced skin turgor
Reduced urine output
Reduced activity level - more sleepy than usual
Tachypnoea
Tachycardia
Reduced CRT
Eyes sunken and tearless
Hypotension
17
Q

What is the clinical triad for meningitis?

A

Neck pain/stiffness and other meningeal signs (photophobia, Kernig’s sign)
Fever
Headache

18
Q

What is the main difference between meningitis and meningococcal septicaemia?

A

Meningitis - presence of menigeal signs such as photophobia, neck stiffness, high pitched cry and positive Kernig’s and Brudzinski’s signs.
Meningococcal septicaemia - signs of systemic disease, inc. shock - cool peripheries, tachycardia, hypotension, prolonged CRT, altered mental state, leg pain, poor urine output.

19
Q

What is the first line treatment for someone with suspected meningitis or meningococcal disease in a child?

A

Emergency transfer to hospital

Parenteral Benzylpenicillin

20
Q

In secondary care, what treatment should be given to someone with a non blanching rash and signs of meningitis or meningococcal disease?

A

IV ceftriaxone

21
Q

Contraindications to performing an LP?

A 
Shock
Raised ICP
Convulsions
Spreading or extensive purpura
Coagulation abnormalities
Superficial infection at LP site
Respiratory insufficiency
22
Q

Choice of treatment of a neonate (<3 months) with bacterial meningitis?

A

Cefotaxime with Amoxicillin

23
Q

What is the most common cause of viral meningitis in immunocompetent adults?

A

Enteroviruses

Others -
HSV
VZV

24
Q

What is the cause of bronchiolitis and what age does it occur?

A

RSV

<2 years

25
Q

What is the cause of croup and what age does it occur?

A

Parainfluenza virus

6 months - 6 years

26
Q

What are the causes of viral pneumonia?

A

RSV
Parainfluenza
Adenovirus
Rhinovirus

27
Q

What is the stepwise management of asthma and when can it be diagnosed?

A

> 4 years

SABA - ICS - LABA - LRA - Increase ICS - Oral Steroids

28
Q

What are the classic features of autism?

A

Impairment in social relationships
Impairment in social communication
Impairment in imaginative thought

29
Q

Key features of ADHD?

A

Inattention
Impulsivity
Hyperactivity

30
Q

What can cause a metabolic acidosis and high ammonia?

A

Cardiac failure
Inborn error of metabolism
Sepsis
Liver failure

31
Q

What are the main groups of inborn errors of metabolism that cause a hyperammonaemia?

A

Urea cycle disorders - ammonia typically >1000 with a resp alkalosis on ABG
Organic Acidaemias - mixed picture, with lower ammonia than in urea cycle disorders, raised anion gap - remember these are not tested for on the Blood Spot test

32
Q

What is the anion gap calculation?

A

(Na + K) - (Bi + Cl)

33
Q

What is the peak age of presentation of intussusception?

A

3 months - 2 years

34
Q

What is the most common cause of acute renal failure in children?

A

Haemolytic Uraemic Syndrome secondary to E.coli infection

35
Q

What is the peak age of presentation for pyloric stenosis?

A

2-6 weeks of age

36
Q

What is the most common cause of food poisoning in the UK?

A

Campylobacter

Paeds OSCE (3 decks)

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