Diagnosis Flashcards by Toni Whitaker

4 hr term infant
no antenatal complications or issues during delivery
incr work of breathing
RR:55 SpO2: 86%
hyperexpanded
reduced breath sounds on L

pneumothorax

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18hr old neonate
hypotensive
desaturated
drowsy

infection: likely organism =
Gp Bstrep
start benpen + gentamycin
covers all causes of perinatal infection: GpB strep, listeria, G-ve

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floppy term baby
post emergency c section
apnoeic
HR: 50
APGAR: 1

Action:
dry (can lose 0.5 degrees C/min)
assess APGAR
rescue breaths
CPR
much later consider:
intubate
atropine

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neonate born at 28 weeks

90% chance of survival

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6 day old 
central cyanosis
no murmur
SpO2: 85%
otherwise well

e. hyperoxic test
prostaglandin E2 infusion started
cardiac centr -> echo
surgery

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5 month old girl
prev well
1/7 hx fever, reduced feeding,
drowsy, irritable
T: 39, RR: 33, HR: 150
fontanelle not bulging

urine dip mc+s
FBC CRP blood cultures
LP
no CT given incr ICP unlikely,
radiation exposure and sedation needed

ceftriaxone!
HiB, strep pneumnoiae, neisseria meningitidis

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ruling out meningitis

e. none

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10 wk baby

vomiting after feeding

gastro oesophageal reflux
pyloric stenosis (if projectile)

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4 yo known asthmatic
RR: 45 SpO2: 93% high flow 02
sub + inter costal recession at rest
despite:
1 salbutamol neb
oral pred

2nd salbutamol neb
later if needed:
atrovent neb
salbutamol infuson
amnophylline

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large VSD

6 wk old

pansystolic murmur
acyanotic heart defect
L->R shunt inc pulm blood flow -> pulm htn + oedema
=resp distress

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10 yo
distended abdomen
periorbital swelling
prev well
no GI sx

nephrotic synd

proteinuria 3g/24hr
albuminaemia

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8 month baby
barking cough
mod stridor 
intercostal recession on exertion
well perfused
T:37.8

croup

nebulised steroids

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2 yo 
sudden onset cough + DIB
prev well
incr work of breathing
reduced breath sound on R
tachypnoea

?binhaled foreign body

?crule out pneumothorax

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10 yo
3 yr hx constipation
prev normal
no medication

osmotic laxative initially
dietary advice:
increase fibre and fluid intake
later possibly add stimulant laxative
manual evacuation = last resort

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8 hour old neonate
oligo hydramnios
c section
L ankle deformity
int deviated

low liquor vol = cause

physical compression = talipes

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4 yo
4x diarrhoea with blood + mucus
2x vomit
tachycardic
T:39.2

salmonella
rotavirus: unlikely to cause bloody stools
UC: unlikely given age
coeliac: chronic steatorrhoea no vomiting

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12 wk s

cousin had child w spina bifida

failure of neural tube to close
top- anencephaly/encephalocoele
generally fatal as brain exposed
mid/bottom- spina bifida
hydrocephalus can develop due to assoc Arnold-Chiari malformation

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14 yo
4 wk limp
no trauma

int rotated + short limb with slipped fem epiph

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signs of sinister seizure

focal features e.g. eye deviation
prolonged >10 mins
change in conscious level before or after
developmental delay

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9 month baby

97th centile head circumference

splaying of cranial sutures suggests incr CSF vol

sun setting eyes occur in severe hydrocephalus

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5 yo epileptic

still fitting after 5 mins

pr diazepam
iv lorazepam
iv phenytoin

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widely spaced nipples

Turners

low set ears

Trisomies

hairy pigmented patch on spine

spina bifida occulta

Goldenhar's syndrome

unilateral facial defects, affecting jaw + ear

physical signs and obs of 6 wk baby

HR 110-160 RR: 30-40 upgoing plantar reflexes until walking around 12 months atonic primitive neck reflex should disappear by 3 months 2cm liver margin normal

18 months pale Hb 65 sperocytes

sperocytosis

5 yo boy | 13cm on tender mass L side abdomen

``` Wilm's tumour 20% of paeds malignancy unilateral L kidney in males nephroblastoma nephrectomy + chemo ```

``` 8yo unwell 4 wks severe anaemia low platelets raised white cells ```

ALL

newborn fails to pass meconium abdo distension bile stained vomit abdo xray:

Hirschsprung's disease presents in infancy rectal suction biopsy

``` 18 months pale Hb 65 hypochromic microcytic pencil cells target cells ```

Fe deficiency anaemia

``` 4yo 1/52 coryza, fever incr drowsiness over past day reduced feeding HR:80 BP: 120/80 ```

Neisseria meningitidis

``` 8 month old 20 min L sided seizure -> unconscious 1/7 hx lethargy sister has cold sores no rash ```

HSV

``` 3 month old febrile 38.7 2 x clear fluid vomits otherwise well urine dip +++ve leucocytes ```

E.coli

9 month old 2/7 vomiting with bile 1 x bloody stool abdo distension

intussusception

14 month old 4/7 watery diarrhoea & vomiting with 37.5 fever no blood in stool dehydrated but stable

rotavirus

4yo 4/7 fever + vomiting multiple episodes watery diarrhoea

rotavirus

3 wk term baby apnoeic episodes, coryza + cough afebrile brother has cough + cold

RSV

2 yr old 4/7 fever + bloody diarrhoea haemolytic anaemia raised urea

E.coli 0157

3 yo prev viral gastritis diarrhoea symptoms worse following joghurt snacks

lactose intolerance

6yo numerous episodes diarrhoea sometimes bloody prev on PICU

pseudomembranous colitis

3 yo 3/52 hx increasing irritability, 1/7 hx visual disturbance, vomiting now unresponsive

intracranial tumour

``` 5 day old poor feeding unresponsive, floppy a febrile otherwise normal consanguinity ```

hyperammonaemia

``` 5 wk stopped breathing at home -> A+E unresponsive irregular breathing nappy rash torn frenulum ```

NAI

2 wk old bronchiolitis IVF: 10% dextrose/0.18%NaCl full maintenance 3/7 now unresponsive

hyponatraemic

2 month old 2/7 hx drowsiness and fever no rash unresponsive

meningitis

How do you asses dehydration clinically?

``` Capillary refill time: prolonged Skin turgor: reduced Pulse: weak, tachycardic Resp: abnormal pattern Extremities: cool, poorly perfuse ```

4 month old Vomiting, poor feeding, excessive crying 8 hrs Normal growth + dev Appears unwell, tender in lower R quadrant, mass felt

Inguinal hernia

15 yr old male Vomiting Pain in abdomen Red swollen right testicle

Testicular torsion

``` 8 yr old male Swollen red right scrotum Upper region of testicle is tender Cremasteric reflex present No nausea or vomiting ```

Torsion of hydatid of Morgagni

3 month old Resp arrest Frenulum torn Bruising around chest wall

Intracranial haemorrhage secondary to NAI | Vigorous shaking -> subdural haemorrhage

2 yr old Fever Resp rate >50

Pneumonia Viral or bacterial Crepitations won't be heard

6 month old Cough, fever, coryza Crepitations throughout lungfields

Bronchiolitis Caused by RSV Resp distress + wheezing due to small airway obstruction