diagnosis Flashcards

1
Q

projectile vomiting first few months life, gastric peristalsis, palpable abdo mass, dehydrated

A

pyloric stenosis

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2
Q

what should differentials be for lower abdo pain in child

A

exclude appendicitis, dkA, hepatitis, lower lobe pneumonia, pyelopnephritis, strangulated inguinal hernia, testicular torsion

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3
Q

usually occurs between 3 months and 2 yrs, colicky pain, pallow, abdo mass, redcurrant jelly stool. treat with reduction then surgery if fails -

A

intussuception

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4
Q

common causes of gastroenteritis in infants?

A

campylobacter, shigella and salmonela most common causes

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5
Q

What should be concerned about in gastroenteritis in infants?

A

dehydration

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6
Q

8-24 yrs age with abnormal stool, poor growth, distension, muscle wasting, anaemia, abdo pain.

A

gluten sensitive enteropathy - coeliacs

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7
Q

How do you diagnose coeliacs?

A

Do IgA, tissue transgluatminase, endomysial Ab, duodenal biopsy

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8
Q

What is hirschprungs?

A

absence of mysenteric plexus of rectum- have obstruction in newborn and cant pass meoconium - later on have constipation, growth fail and abdo distention

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9
Q

How do you mx hirschprungs?

A

sunction rectal biopsy

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10
Q

oedema, proteinuria and low albumin, no haematuria, normal BP, steroid-sensitive syndrome

A

nephrotic syndrome

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11
Q

oedema, htn, low UO, haematuria and proteinuria

A

nephritic syndrome

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12
Q

causes of nephritic syndrome

A

post-strep, henoch schonlein purpura, IgA nephropathy

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13
Q

infant UTI presentation

A

fever, vomit, lethargy, irritable, poor feed/growth, jaundice, spetic, offensive urine, febrile seizure

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14
Q

Child UTI presentation

A

febrile seizure; dysuria, freq, urgency, abdo pain, fever, lethargy, anorexia, vomit, diarrhoea, haematuria, offensive urine, enuresireoccurs

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15
Q

What should you ask about in a paeds hx?

A

need to clarify who collateral hx is from
antenatal / postnatal
gestation
Growth scans
Mode of delivery
Complications in pregnancy and birth – drugs or infection, hospital stays
USS
Ask for red book
Apgar
Immunisations - askif up to date
Development - Ask the parent what they can do ; Motor, speech, language and vision
Family history
Neonate deaths – CONE scheme
Siblings- age, onset, health, age, may ask about height and weight
Social history
Second hand smoking
Whos at home, who looks after child
School or pre- school —? More likely to get infections
Social services involvement if appropriate
Pets
HEEADSSS - teens

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16
Q

Describe how to do a cardio exam on a child

A

Feel for apex beat, thrills (palpable murmurs) and heaves
FEMORAL PULSE IF NEONATE
Hepatomegaly!!!!!!! - sig heart failure in infants
Heart failure- presents as oedema in groin- perianal and orbital NOT pitting
Fontanel (soft spot on head) —> goes in if dehydrated, up if raise in ICP

17
Q

describe how to do a resp exam on a child

A

Head bobbing, grunting, sternomastoid recession, trachel tug and sighing at end of breath and nasal flaring if struggle to breathe and use accessory muscles
RR and other obs are different – PEWS chart
Cyanosis – look on hands - and tongue for central
Clubbing – CF, congenital heart disease, IBD
Hyperexpansion/ barrel shape chest in asthma
Chest expansion
Location apex beat – mediastinal shift

18
Q

What signs may you see in a child with bronchiolitis?

A

Bronchiolitis: laboured breathing, hyperinflation, chest recession. Hyper resonant, fine crackles all zones, wheeze possible

19
Q

What signs may you see in a child with pneumonia?

A

Pneumonia: reduced chest movement and rapid shallow breaths, dull percussion and bronchial breathing/ crackles on auscultation

20
Q

What signs may you see in a child with asthma?

A

Asthma: use accessory muscles, hyper resonant on percussion, wheeze on auscultation

21
Q

What signs may you see in a child with croup?

A

Croup: chest wall retraction, stridor. Normal percussion

22
Q

how do you do a CN exam in a child?

A

1- smell
2-acuity
3, 4 and 6-fields if old enough to cooperate, light test pupils, squint? Nystagmus? accomodation
5- clench teeth and waggle jaw, feeling
7-eyes tight, cheeks, smile, show teeth, raise brows
8-whisper number
9, 10- ahhh - look palate, voice, cough, swallow
11-shrug shoulders and turn head with resistance
12-put out tongue

23
Q

How do you do an abdo exam on a child?

A

Actually do ISHRUG if in nappies apart from RECTAL – never do PR on a child
Liver, spleen, kidney, bladder
Localised pain in appendicitis, hepatitis and peritonitis
Liver and spleen may be 1-2cm below costal margin in infants

24
Q

What are causes of hepatomegaly in children?

A

Hepatomegaly causes: malaria, SCD, portal hypertension, leukaemia, lymphoma, wilms tumour, lipid storage disorder, heart failure

25
Q

What are causes of splenomegaly in children?

A

Splenomegaly causes: viral or bacterial infection, haemolytic anaemia, leukaemia, lymphoma, still’s disease