Paediatric cases Flashcards
Baby 1 (3m, Vomiting and unsettled):
“He weighs 11lbs, he usually takes a 7oz feed 6 times per day, he always seems hungry and unsettled after his feed.
What should we do?”
in kg what does he weight?
What are his feed volumes? (per feed)
What are his feed volumes? (per kilo per day)
advice to give parents…
5kg
210ml 6 times a day
250ml/kg/day
parents are overfeeding , 120-140ml/kg/day is the recommended feed volume, so feed the baby less.
Baby 2 (6m Bronchiolitis and feeding concerns):
“She weighs 151/2lbs, she usually takes a 10oz feed 5 times per day, she has just been taking 4oz every 3 hours. What should we do?”
What does she weigh?
What are her usual feed volumes? (per feed)
What are her usual feed volumes? (kg/day)
What are her current feed volumes? (per feed)
What are her current feed volumes? (kg/day)
What advice should you give the parents?
weights 7kg
What are her usual feed volumes? (per feed) - 215ml/kg
What are her usual feed volumes? (kg/day)
What are her current feed volumes? (per feed)
What are her current feed volumes? (kg/day)
What advice should you give the parents?
feed the child more,
Case 3: A 6y old boy presents with 12m of abdominal pain. He passes stools 1/week with occasional blood. He is on the 98th weight centile and 50th height centile.
Examination shows small soft masses in the LLQ
what is the diagnosis?
Additional features of the history/ examination?
Management?
Diagnosis? constipation - relative infrequenty of stool, feels stool masses
Additional features of the history/
examination? ask about diet (fibre), fluids, what kind of stool is he passing, lower limb neurology, palpate the stomach, look at the lower spine and anus, look for extra-gastrointestinal manifestations.
Management? laxative for months, stool softeners, dietary advice - fibre, more fruit and veg, less milk. toilet routine,
A 10 week old boy presents with 4 weeks of frequent post feed effortless vomits and distress (back arching and pulling up knees).
Examination showed a soft abdomen with no palpable masses.
Diagnosis and differential?
Other questions to ask?
Management and investigations?
Diagnosis and differential? GORD
Other questions to ask? are they on formula, regularity, what kind of formula,
Management and investigations?
2y old boy referred for poor weight gain and loose, pale stools (1 year, 3-4 times/day)+ flatus, miserable. Picky eater, all normal diet, formula fed, tried milk free diet- no benefit.
No significant past illness or family history
Examination; Pale, less sub cutaneous fat, muscle wasting, distended abdomen
Diagnosis?
Investigations?
Management?
Diagnosis?
Investigations?
Management?
A 2 week old baby present with a 2 day history of vomiting all feeds. The parents bring in one of his baby grows. Weight is down 30g.
He is unsettled on examination
Differential diagnosis?
Investigations?
Management?
Differential diagnosis? bilious vomiting
Investigations?
Management?
A 9 month old girl presents with 48h of increasing wheeze and respiratory effort and a 4d history of mild runny nose and cough.
Examination shows bilateral wheeze and crackles. She has sub-costal recession, a pink throat and red ears. Resp rate 60, Sats 93% and temp 37.9o
Diagnosis and differential?
Investigations?
Management? And role for medication?
Diagnosis and differential? pneumococcus infection, LRTI, bronchiolitis.
Investigations? No
Management? And role for medication? Observation, support oxygenation, hydration and nutrition.
An 18m boy presents with a 4 hour history of barking cough and noisy breathing having been well the day before
Examination shows a runny nose, loud stridor, tracheal tug sub-costal recession, well perfused peripheries and temp of 37.8o
Diagnosis and differential?
Management and investigation?
diagnosis and differential?
Management and investigation?
no tests for croup, give oral dexamethasone (if worse give iv adrenaline).
A 3y old girl presents with a 4 day history of increasing lethargy, cough, fever and tummy pain. She has vomited x4 in the last 2 days.
Examination showed temp 39.8o, resp rate 40, nasal flaring, intercostal recession, no focal chest findings, RUQ discomfort, soft abdomen.
Diagnosis and differential?
Investigation and management?
Diagnosis and differential?
Investigation and management?
You observe a young male child doing the following activities (you will be shown 2 video clips during the session)
Which developmental domains are being demonstrated?
What is the most advanced skill seen for each area?
How many months old is the child?
Which developmental domains are being demonstrated?
What is the most advanced skill seen for each area?
How many months old is the child?
