Common Presentations and Differentials Flashcards
What are the differentials in a failure to thrive history?
Pyloric Stenosis Coeliac Disease IBD Eating Disorder GORD Cystic Fibrosis Cows milk protein allergy Lactose Intolerance Neglect
What systems reviews do you ask in a failure to thrive history?
General
GI
What are the key questions to ask in a failure to thrive history?
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
What are the differentials in a weight gain history?
Obesity Familial Obesity Cushing's Syndrome Hypothyroidism PCOS
What are the differentials in a childhood bruising history?
NAI AI ITP HSP Meningococcal Septicaemia
What are the differentials in a global developmental delay history?
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
What are the differentials in a delayed walking history?
Duchenne’s Muscular Dystrophy
Cerebral Palsy
Developmental Dysplasia of the Hip
What are the differentials in a delayed speech history?
Deafness
Neglect/abuse
Cleft palate
Familial
What are the differentials in a early puberty history?
Adrenal tumour/hyperplasia Ovarian/testicular tumour Familial Intracranial tumour CNS problem e.g. hydrocephalus
What are the differentials in a delayed puberty history?
Constitutional Hypothyroidism Systemic disease Turner's - 45 XO Klinefelter's - 47 XXY PCOS
What are the differentials in a fits/faints history?
NEAD Epilepsy Breath holding Reflex Anoxic Syndrome Febrile Convulsions Vasovagal
What are the main causes of tachycardia in children?
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)
What are the main causes of tachypnoea in children?
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
What could be the cause of a neonate who is more sleepy than usual?
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
What are the key things looked at in the traffic light system for recognising the seriously unwell child?
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
What are the signs of dehydration in a child?
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
What is the clinical triad for meningitis?
Neck pain/stiffness and other meningeal signs (photophobia, Kernig’s sign)
Fever
Headache
What is the main difference between meningitis and meningococcal septicaemia?
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.
What is the first line treatment for someone with suspected meningitis or meningococcal disease in a child?
Emergency transfer to hospital
Parenteral Benzylpenicillin
In secondary care, what treatment should be given to someone with a non blanching rash and signs of meningitis or meningococcal disease?
IV ceftriaxone
Contraindications to performing an LP?
Shock Raised ICP Convulsions Spreading or extensive purpura Coagulation abnormalities Superficial infection at LP site Respiratory insufficiency
Choice of treatment of a neonate (<3 months) with bacterial meningitis?
Cefotaxime with Amoxicillin
What is the most common cause of viral meningitis in immunocompetent adults?
Enteroviruses
Others -
HSV
VZV
What is the cause of bronchiolitis and what age does it occur?
RSV
<2 years
What is the cause of croup and what age does it occur?
Parainfluenza virus
6 months - 6 years
What are the causes of viral pneumonia?
RSV
Parainfluenza
Adenovirus
Rhinovirus
What is the stepwise management of asthma and when can it be diagnosed?
> 4 years
SABA - ICS - LABA - LRA - Increase ICS - Oral Steroids
What are the classic features of autism?
Impairment in social relationships
Impairment in social communication
Impairment in imaginative thought
Key features of ADHD?
Inattention
Impulsivity
Hyperactivity
What can cause a metabolic acidosis and high ammonia?
Cardiac failure
Inborn error of metabolism
Sepsis
Liver failure
What are the main groups of inborn errors of metabolism that cause a hyperammonaemia?
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
What is the anion gap calculation?
(Na + K) - (Bi + Cl)
What is the peak age of presentation of intussusception?
3 months - 2 years
What is the most common cause of acute renal failure in children?
Haemolytic Uraemic Syndrome secondary to E.coli infection
What is the peak age of presentation for pyloric stenosis?
2-6 weeks of age
What is the most common cause of food poisoning in the UK?
Campylobacter
