diagnosis Flashcards
projectile vomiting first few months life, gastric peristalsis, palpable abdo mass, dehydrated
pyloric stenosis
what should differentials be for lower abdo pain in child
exclude appendicitis, dkA, hepatitis, lower lobe pneumonia, pyelopnephritis, strangulated inguinal hernia, testicular torsion
usually occurs between 3 months and 2 yrs, colicky pain, pallow, abdo mass, redcurrant jelly stool. treat with reduction then surgery if fails -
intussuception
common causes of gastroenteritis in infants?
campylobacter, shigella and salmonela most common causes
What should be concerned about in gastroenteritis in infants?
dehydration
8-24 yrs age with abnormal stool, poor growth, distension, muscle wasting, anaemia, abdo pain.
gluten sensitive enteropathy - coeliacs
How do you diagnose coeliacs?
Do IgA, tissue transgluatminase, endomysial Ab, duodenal biopsy
What is hirschprungs?
absence of mysenteric plexus of rectum- have obstruction in newborn and cant pass meoconium - later on have constipation, growth fail and abdo distention
How do you mx hirschprungs?
sunction rectal biopsy
oedema, proteinuria and low albumin, no haematuria, normal BP, steroid-sensitive syndrome
nephrotic syndrome
oedema, htn, low UO, haematuria and proteinuria
nephritic syndrome
causes of nephritic syndrome
post-strep, henoch schonlein purpura, IgA nephropathy
infant UTI presentation
fever, vomit, lethargy, irritable, poor feed/growth, jaundice, spetic, offensive urine, febrile seizure
Child UTI presentation
febrile seizure; dysuria, freq, urgency, abdo pain, fever, lethargy, anorexia, vomit, diarrhoea, haematuria, offensive urine, enuresireoccurs
What should you ask about in a paeds hx?
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
Describe how to do a cardio exam on a child
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
describe how to do a resp exam on a child
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
What signs may you see in a child with bronchiolitis?
Bronchiolitis: laboured breathing, hyperinflation, chest recession. Hyper resonant, fine crackles all zones, wheeze possible
What signs may you see in a child with pneumonia?
Pneumonia: reduced chest movement and rapid shallow breaths, dull percussion and bronchial breathing/ crackles on auscultation
What signs may you see in a child with asthma?
Asthma: use accessory muscles, hyper resonant on percussion, wheeze on auscultation
What signs may you see in a child with croup?
Croup: chest wall retraction, stridor. Normal percussion
how do you do a CN exam in a child?
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
How do you do an abdo exam on a child?
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
What are causes of hepatomegaly in children?
Hepatomegaly causes: malaria, SCD, portal hypertension, leukaemia, lymphoma, wilms tumour, lipid storage disorder, heart failure
