DDx

Question 1

Abdominal Pain - acute in children
Murtagh
Probability Dx
Serious / not to be missed
Often missed
Masquerades

Answer 1

Probability Dx
- infant colic (2-16/52)
- gastroenteritis
- mesenteric adenitis (enlarged abdo LNs)

Serious / not to be missed
- infection: appendicitis, pneumonia, pyelonephritis, peritonitis
- malignancy: colon Ca
- other: intussusception, bowel obstruction, Coeliac disease, incarcerated hernia

Often missed
- child abuse
- constipation
- testicular torsion
- lactose intolerance
- peptic ulcer
- ovarian cyst rupture/torsion

Masquerades
- diabetes
- drugs
- UTI
- depression / psychogenic

Question 2

Abdominal pain - recurrent in children
Murtagh
Probability Dx
Serious / not to be missed
Often missed
Masquerades

Answer 2

Probability Dx
- psychogenic
- constipation
- recurrent viral illness (mesenteric adenitis)

Serious / not to be missed
- infection: recurrent UTI, parasitic gut infection, TB
- malignancy: colon Cca
- other: hydronephrosis

Often missed
- IBD
- abdominal migraine
- food allergy
- GORD

Masquerades
- depression / psychogenic
- diabetes
- drugs
- spinal dysfunction
- UTI

Question 3

Primary headache key features / which DDx

Bilateral pain location
Pressure/tightening pain quality
Mild-mod pain intensity
Not aggravated by ADLs
30mins-continuous duration

Answer 3

TENSION-TYPE HEADACHE

Episodic if <15 days / month
Chronic if >15 days / month for >3 months

Question 4

Primary headache key features / which DDx

Unilateral or bilateral pain location
Pulsating pain quality
Mod-severe pain intensity
Aggravated by or causes avoidance of ADLs
4-72hr duration

Answer 4

MIGRAINE +/- aura

Episodic if <15 days / month
Chronic if >15 days / month for >3 months

Question 5

Primary headache key features / which DDx

Unilateral, often around eye or side of face pain location
Variable pain quality
Severe-very severe pain intensity
Causes restlessness or agitation
15-180min duration

Answer 5

CLUSTER HEADACHE

Episodic if 1 alt daily - 8 per day, w >1m remission
Chronic if 1 alt daily - 8 per day, w <1m remission in 12m

Question 6

Headache associated features / which DDx

None

Answer 6

TENSION-TYPE HEADACHE

Question 7

Headache associated features / which DDx

Sensitivity to light/sound
N&V
Neurological Sx

Answer 7

MIGRAINE

Question 8

Primary headache associated features / which DDx

Red / watery eye
Nasal congestion / runny nose
Swollen eyelid
Forehead / facial sweating
Constricted pupil / drooping eyelid

Answer 8

CLUSTER HEADACHE