Outpatients

Question 1

top 10 reasons for GP referral

Answer 1

1. growth concerns
2. UTI
3. constipation
4. abdominal pain
5. headaches
6. funny turns
7. heart mumur
8. food allergies and intolerances
9. minor abnormalities (abnormal growth and development)
10. asthma

Question 2

most common referral for growth concerns

Answer 2

short stature (familial or constitutional delay)
obesity with short stature could have endocrine cause (red flag)

Question 3

what needs to be detected in UTI

Answer 3

vesicouretic reflux
renal scarring
renal tract abnormalities

Question 4

red flags in UTI

Answer 4

younger
frequent infections
non- E.coli pathogen
FH of renal disease
poor growth/general health
poor urinary flow
voiding problems/constipation
spinal abnormality 
raised BP
renal tract abnormalities on antenatal scan
abdominal mass

Question 5

define constipation

Answer 5

pain, difficulty or delay in defaecation

Question 6

management of constipation

Answer 6

laxatives
attention to diet
toileting advice

Question 7

red flag for constipation

Answer 7

no passage of meconium more than 24 hours after birth

Question 8

underlying disease presenting with constipation that can be refractory to treatment or onset from infancy

Answer 8

Hirschsprung's
metabolic (thyroid)
Coeliac
anorectal abnormalities
neuromuscular

Question 9

abdominal pain diagnoses not to miss

Answer 9

Coeliac’s
IBD
malrotation
intermittent volvulus

Question 10

red flags for abdominal pain

Answer 10

involuntary weight loss
deceleration of linear growth
GI blood loss
significant vomiting, especially if bile
chronic severe diarrhoea
unexplained fever
location of pain (epigastric= heart burn, RIF= appendicitis)
FH of IBD
recurrent mouth ulcers
perianal disease

Question 11

red flags for headaches

Answer 11

headache on waking/worse with coughing or bending (raised intracranial pressure)
associated vomiting, especially in morning
visual disturbance
gait disturbance
cranial nerve palsy

Question 12

examples of funny turns

Answer 12

seizures
breath-holding
reflex anoxic seizures
benign neonatal sleep myoclonus
night terror
gratification disorders
faints
cardiac
ALTE
toxins

Question 13

red flags for cardiac syncope in children

Answer 13

• syncope with known congenital heart disease
• during exercise or when supine
• FH of sudden death, prolonged QT or hypertrophic cardiomyopathy
• preceded by palpitations
• heart murmur

Question 14

innocent heart murmur presentation

Answer 14

systolic
low intensity
2nd left ICS
medial to apex
beneath clavicle (continuous venous hum that disappears when supine)

Question 15

red flag heart murmur

Answer 15

diastolic
loud
harsh
thrill
radiates
other symptoms/signs (e.g. dysmorphism)

Question 16

diagnosis of asthma in child

Answer 16

unable to do testing so diagnosis of likelihood