Paediatric GP Presentations Flashcards
Concerns regarding growth?
Short stature:
• Familial
• Constitutional delay
Obesity:
• Energy in VS energy used
Occurrence of UTIs?
Very common in children
Potential cause to consider with UTIs in children?
Renal tract abnormality, esp if:
• Unusual microbes cultured
Signs that suggest an upper UTI?
Fever
Loin/abdominal pain
Signs that suggest a lower UTI?
Generally systemically well
Loss of continence, etc
Examples of complicated renal issues?
Vesicoureteric reflux (likely to have a +ve FH)
Renal scarring
Renal tract abnormalities
Concerning features in UTIs?
Frequent infections
Non-E.coli pathogens
FH of renal disease
Poor growth/general health
Poor urinary glow in infant, e.g: due to a posterior urethral valve
Voiding problems/constipation
Spinal abnormality (neuropathic bladder results)
Raised blood pressure (requires the use of centile charts and the correct tools)
Renal tract abnormalities on antenatal scan
Abdominal mass
What is a posterior urethral valve?
Obstructing membrane in the posterior male urethra as a result of abnormal in utero development
Most common bacterial cause of uncomplicated UTI in children?
E. coli
Constipation definition?
Pain, difficulty or delay in defaecation
Soiling definition?
Escape of stool into the underclothing
Encopresis definition?
Passage of normal stools in abnormal places; same as soiling?
Cause is often psychological/behavioural
Organic disease causes of constipation?
Rare but consider if the onset is from early infancy or refractory to treatment: • Hirschsprung's • Metabolic (thyroid) • Coeliac disease • Anorectal abnormalities • Neuromuscular
Red flag sign in constipation?
Delay in passage of meconium >24 hours after birth
Causes of abdominal pain?
Often no serious underlying cause but cannot miss:
• Coeliac disease
• IBD (bloody diarrhoea, malnutrition, etc)
• Malrotation and intermittent volvulus (bile-stained vomit, etc)
Concerning features with abdominal pain?
Involuntary weight loss
Deceleration of linear growth
GI blood loss
Significant vomiting
Chronic severe diarrhoea
Unexplained fever
Persistent right upper or right lower quadrant pain
FH of IBD
Relationship between functional abdominal pain and anxiety?
If a child has functional abdominal pain, they are more likely to develop anxiety disorder as an adult
Concerning features with headaches?
- Headache on waking
- Worse with coughing/bending
- Associated vomiting, esp. in the morning
- Visual disturbance
- Gait disturbance
- Cranial nerve palsy
Median symptoms interval time (time between symptoms onset and diagnosis) for childhood brain tumours is approximately?
2.5-3 months
Causes of “funny turns”?
Seizures
Breath-holding
Reflex anoxic seizures
Benign neonatal sleep myoclonus
Night terrors
Gratification disorder
Faints
Cardiac
ALTE
Red flag signs for cardiac syncope in children?
Syncope in a child with known congenital heart disease
Syncope during exercise or when supine
FH of sudden death, e.g: due to prolonged QT syndrome OR hypertrophic cardiomyopathy
Syncope preceded by palpitations
Heart murmur or other abnormalities on CV examination
Associated symptoms that may occur with heart murmurs?
Breathless and blue
Pale
Sweaty
Poor feeding
Characteristics of innocent murmurs?
Systolic and low intensity:
• 2nd left interspace
• Medial to apex
• Beneath either clavicle (may be continuous- ‘venous hum’ –disappears when supine)
Red flag signs with heart murmurs?
Any diastolic murmur
Loud ≥ grade 3
Harsh sound
Associated thrill
Radiate widely
Other symptoms/signs, e.g: • Breathless • Poor feeding • Pallor • Sweating • Syncope • Poor growth • Dysmorphism • FH
Potential causes of a heart murmur?
Ventricular-septal defect
Atrial-septal defect
Patent ductus arteriosus
Commonest heart murmur in childhood?
Innocent heart murmur
Differences between food allergy and food intolerance?
Food allergy - type 1 IgE mediated acute allergic reaction; can cause anaphylaxis
Food intolerance - delayed reaction; symptoms are more varies and mechanism is unclear
Minor abnormalities that present in infants?
Head shape and size
Skin lesions
Feeding concerns
Crying excessively
Concerning features in infants?
Abnormal growth (weight and OFC - head circumference)
Concerns about development
Symptoms in infants are non-specific (low index of suspicion)
Clinical features that increase the likelihood of the diagnosis being asthma?
PMH of atopic disease
FH of atopic disease and/or asthma
Widespread wheeze heard on auscultation
>1 of the following symptoms: • Wheeze • Cough • Difficulty breathing • Chest tightness
Other features that suggest symptoms are asthma-related?
If they are:
Frequent/recurrent
Worse at night/early morning
Occur in response to/are worse after exercise or other triggers, e.g: pets, pollen, cold/damp air, with emotion/laughter
Occur apart from colds
