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Paeds > Diagnoses, Signs and symptoms > Flashcards

Diagnoses, Signs and symptoms Flashcards

1
Q

Name 6 causes of dehydration due to excessive loss of fluid

A
  • Excessive sweating (fever, hot climate, cystic fibrosis)
  • Vomiting (pyloric stenosis, viral infections, gastroenteritis)
  • Acute diarrhoea (viral+ bacterial gastroenteritis, antibiotic induced, food poisoning, acute infection)
  • Burns
  • Post surgery
  • Polyuria (diabetes mellitus, SIADH)
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2
Q

Name 2 causes of inadequate intake of fluids-> dehydration

A
  • Inability to drink (herpes stomatitis, acute tonsillitis)

* Inadequate access to water

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3
Q

What investigations should be carried out in a child with severe dehydration?

A
  • U+Es (electrolyte imbalance and renal function)
  • Blood gas (metabolic imbalance)
  • Urinalysis (osmolality)
  • Blood sugar (DKA?)
  • Stool culture (in gastroenteritis and food poisoning)
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4
Q

How do you assess degree of dehydration?

A

Mild: only sign is dry lips, (<5%)

Moderate: dry lips, reduced urine output, lethargic, tachycardia, normal BP, delayed cap refill, sunken fontanelle, reduced skin turgor (5-10%)

Severe: dry lips, no urine output for last 12 hrs, irritable/coma, tachycardia, low BP, very delayed cap refill, very sunken fontanelle, very reduced skin turgor (>10%) = hypovolaemic shock

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5
Q

Treatment of severe dehydration

A
  • Oral rehydration where possible
  • Treat shock with bolus of IV fluids
  • Rehydrate slowly over 24hrs
  • Correct electrolyte imbalance
  • Do not prescribe antibiotics is uncomplicated gastroenteritis
  • Probiotics?
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6
Q

What metabolic imbalances would you expect in someone who’s profoundly dehydrated due to diarrhoea?

A

Metabolic acidosis: Bicarbonate loss from persistent diarrhoea
Hyponatraemia: When diarrhoea contains lots of sodium

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7
Q

What metabolic imbalances would you expect in a persistently vomiting patient

A

Metabolic alkalosis due to H+ loss in vomit

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8
Q

How can IgE be used in diagnosis?

A
  • Total IgE may be used to help screen for and detect allergic disease
  • Allergen specific IgE tests may also be used if potential allergens have been identified
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9
Q

What symptoms would indicate an IgE test to be ordered

A
  • When a person has periodic or persistent symptoms that may be due to an allergic reaction
  • Symptoms: itching, hives, eczema, N+V, diarrhoea, coryzal symptoms, difficulty breathing, asthma symptoms
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10
Q

What does an IgE elevation indicate?

A

Likely person has 1/more allergies

Can also indicate a parasitic infection

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11
Q

What tests are done to investigate a weakness in muscle

A
  • History
  • Examination (eg against resistance/gravity)
  • Neuroimaging (stroke)
  • LP
  • Electromyography
  • Muscle biopsy
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12
Q

Name 9 infections that can cause muscle weakness

A
  • Epstein-Barr virus
  • Human immunodeficiency virus
  • Influenza
  • Lyme disease
  • Meningitis (multiple agents)
  • Polio
  • Rabies
  • Syphilis
  • Toxoplasmosis
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13
Q

What drugs can cause arm weakness?

A
  • Alcohol
  • Chemotherapy agents
  • Antiretrovirals
  • Corticosteroids
  • NSAIDs
  • Statins
  • Penicillin, sulphonamides
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14
Q

What genetic conditions can cause arm weakness?

A

Muscular dystrophy

Mitochondrial disease

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15
Q

What platelet issues can cause a purpuric rash?

A

Impaired platelet production (leukaemia, aplastic anaemia, myeloma)
Drug induced platelet reduction (co-trimoxazole, chemicals)
Excessive platelet destruction (immune mediated, DIC, haemolytic uraemic syndrome)
Splenomegaly
Dilutional loss

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16
Q

Name 7 non-platelet causes of a purpuric rash

A

Congenital infection (rubella, cytomegalovirus)
CT disorder (haemorrhagic telangiectasia)
Septicaemia, meningococcal infections, measles
Autoimmune (HSP, SLE, rheumatoid arthritis)
Drug induced (steroids, sulphonamides)
Senile purpura
Scurvy

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17
Q

What tests need to be done in someone presenting with purpura

A

FBC (rule out leukaemia/aplastic anaemia)
INR (if on warfarin)
Plasma electrophoresis (hypergammaglobulinaemia, paraproteinaemia)
Autoantibody screen (SLE, rheumatoid)
Blood culture (meningococcal/septicaemia)

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18
Q

What questions need to be asked in a child presenting with failure to thrive

A 
See growth chart-> age of onset
Food input (dietary hx, time of weaning, hunger)
Energy output (energy, activity, exercise, anorexic?)
Output: wet nappies, stools, GI symptoms
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19
Q

Which systems would you review in failure to thrive?

A

General (fever, behaviour/activity/alertness/cough)

GI: dysphagia, reflux, vomiting, abdo pain/colic, diarrhoea, constipation, stools)

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20
Q

Name 7 GI causes of failure to thrive

A 
Coeliac
Dietary protein intolerance (cow's milk)
Carbohydrate intolerance (lactose)
Pyloric stenosis
GORD
Cystic fibrosis
IBD
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21
Q

Name 4 behavioural causes of failure to thrive

A 
Not enough food offered
Nutritional neglect
Emotional neglect
Eating disorder
Poor feeding technique (eg problems latching)
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22
Q

Name 4 prenatal causes of failure to thrive

A

Prematurity
IUGR
Chromosomal abnormalities
Toxin (alcohol, drugs, smoking)

23
Q

What else could cause failure to thrive?

A

Inborn errors of metabolism
Chronic infections (HIV)
Chronic illness
Malignancy

24
Q

Name 3 endocrine causes of weight increase

A

Cushing’s
PCOS
Hypothyroidism

25
Q

Name some non-endocrine differentials for weight gain

A 
Obesity (snacking, lack of exercise)
Familial
Oedema (cardiac/renal)
Steroid use
Genetic syndrome (Turner's, Prader Willis)
26
Q

5 causes of language delay

A 
Deafness
Articulation problems (cleft palate)
Familial
Lack of stimulus (neglect)
Autism (ASD)
27
Q

3 Causes of motor delay

A

Cerebral palsy
Muscular dystrophy/muscular disorders
Hip dysplasia

28
Q

4 neuro causes of faint/funny turn/fit

A

Epileptic seizure
Febrile convulsion
Paediatric epileptic syndrome
Reflex anoxic seizure

29
Q

6 non neuro causes for faint/funny turn/fit

A 
Vasovagal syncope
Psuedoseizure
Breath-holding spell
Arrhythmia
Hypertrophic cardiomyopathy
30
Q

Acute causes of a limp

A 
Septic arthritis/tendonitis
Septic osteomyelitis
Tumour/infiltration
Fracture
Sprain/pulled muscle
Slipped femoral epiphysis
31
Q

Chronic causes of a limp

A 
Perthes hip (avascular necrosis)
Sulfie hip
JIA
Cerebral palsy
Muscular dystrophy
32
Q

What are the risks associated with undescended testes?

A
  • Infertility if undescended
  • More likely to become malignant
  • Increased risk of torsion
  • If bilateral, could be female? virilised genitalia
  • Surgeons need to know by 6 months
33
Q

Causes of hoarse voice

A
  • Voice overuse
  • Laryngitis (Upper resp tract infection)
  • Anatomic lesion (vocal cord nodules, webs, laryngeal cysts, tumours, haemangioma)
  • Foreign body
  • Post ventilation
  • Vocal cord paralysis (post surgery)
  • GORD
  • Smoke inhalation
34
Q

3 causes of hypermobility

A
  • Beighton hypermobility score/9
  • Ellas Danlos syndrome, skin is stretchy and velvety
  • Lower muscle tone, lower reflexes
35
Q

Causes of ‘wheeze’

A
  • Prolonged expiratory phase with an expiratory wheeze
  • Chronic: well- bronchomalacia (stridor/wheezed when excited)
  • Chronic unwell: CF,
  • Progressive: triggers? Asthma, GORD/aspiration
  • Acute& mono phonic: foreign body
36
Q

Causes of absent red reflex

A
  • Cataracts (congenital, TORCH, genetic)
  • Retinoblastoma
  • Haemangioma
  • Haemorrhage (birth trauma)
37
Q

What counts as polyuria

A

> 2L/1.7m^2 per day (vol)

Or increased frequency

38
Q

Causes of polyuria

A
  • Endocrine: diabetes mellitus, cranial diabetes insipidus, hypoadrenalism
  • Renal: CKD, renal diabetes insipidus (concentration, volume)
  • Post obstruction
  • Metabolic: hypokalaemia
  • Psychogenic: polydipsia compulsory water drinking
39
Q

What is stridor? Causes?

A
  • Of the lumen: inflammatory, viral croup. Epiglottitis, bacterial. Tracheaitis. Anaphylactic. Smoke inhalation. Laryngomalacia. Post intubation. Vocal cord palsy.
  • In the lumen: foreign body inhalation, growth (nodules/haemangioma/tumour)
  • Outside lumen: aberrant blood vessel, thoracic rib, tumour
40
Q

Red flags in infant with stridor

A

Biphasic, floppy, unwell, hypoxic

41
Q

Causes of acute cough

A
  • Upper/lower respiratory tract infection
  • Pneumonia->bronchitis->tracheitis->laryngitis->epiglottitis->pharyngitis->tonsilits->sinusitis/drip
  • Exacerbation of asthma
  • Allergic
  • Legionnaires
42
Q

Causes of chronic cough

A 
•	TB
•	Farmer’s lung, pigeon fancier’s lung
•	Post nasal
•	GORD
        Heart failure
43
Q

Causes of haemoptysis

A
  • Massive haemoptysis (bronchial bed)
  • TB
  • Cancer
  • CF pneumonia
  • Pneumonia
  • Pulmonary embolism
44
Q

Causes of altered level of conciousness

A

Structural: SOL, stroke, trauma, raised ICP, epilepsy, syncope
Medical: toxins (opiates), sepsis (meningitis, herpes simplex), neurological, metabolic (glucose, ammonia, ketones)

45
Q

Hypocalcaemia symptoms

A

Lowers threshold of muscle excitability

Muscle cramps, lethargy, trusoe’s test

46
Q

Causes of paediatric hypocalcaemia

A
  • Neonatal from diabetic mother

* Low vitamin D

47
Q

Investigations for hypocalcaemia

A
  • U+E, bone profile (Ca, Alb, Pho, AlcPhos)
  • ECG
  • Venous gas (ionised Ca2+)
  • PTH
  • Vit D
  • Magnesium
  • Calcium:creatinine ratio urine test
48
Q

Red flags for limp in child

A

Age <3
Unable to weight bear
Fever
Systemic illness

49
Q

14 month old with swollen abdomen, no GI or urinary symptoms. Large mass on left side that doesn’t cross midline. Is it:

a) intussesception
b) Leukaemia
c) EBV
d) Wilm’s tumour

50
Q 
4 year old with pallor and abdo distention. Splenomegaly is found. She has just arrived from Kenya. 
Which of these are possible diagnoses?
a) ALL
b) Malaria
c) Thalassaemia
d) Hookworm infestation
e) Coeliac
A

a) true
b) true
c) true, more common in Africa, would be minor to show up later
d) false
e) false

51
Q

5 signs of septic arthritis

A 
High fever
Systemically unwell
Marked pain on movement
High acute phase reactant
Hip effusion on USS
52
Q

Define Still’s disease

A

JIA without arthritis

Fever, weight loss, rash, lymphadenopathy

53
Q

Different diagnoses and +ve tests for arthritis in a child

A 
Post strep arthritis (ASO titre +ve)
EBV (blood film and local arthritis)
SLE (ANA and dsDNA +ve)
ALL (abnormal blood film)
JIA diagnosis of exclusion

Paeds (14 decks)

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