Paediatric GP Presentations

Question 1

Concerns regarding growth?

Answer 1

Short stature:
• Familial
• Constitutional delay

Obesity:
• Energy in VS energy used

Question 2

Occurrence of UTIs?

Answer 2

Very common in children

Question 3

Potential cause to consider with UTIs in children?

Answer 3

Renal tract abnormality, esp if:

• Unusual microbes cultured

Question 4

Signs that suggest an upper UTI?

Answer 4

Fever

Loin/abdominal pain

Question 5

Signs that suggest a lower UTI?

Answer 5

Generally systemically well

Loss of continence, etc

Question 6

Examples of complicated renal issues?

Answer 6

Vesicoureteric reflux (likely to have a +ve FH)

Renal scarring

Renal tract abnormalities

Question 7

Concerning features in UTIs?

Answer 7

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

Question 8

What is a posterior urethral valve?

Answer 8

Obstructing membrane in the posterior male urethra as a result of abnormal in utero development

Question 9

Most common bacterial cause of uncomplicated UTI in children?

Answer 9

E. coli

Question 10

Constipation definition?

Answer 10

Pain, difficulty or delay in defaecation

Question 11

Soiling definition?

Answer 11

Escape of stool into the underclothing

Question 12

Encopresis definition?

Answer 12

Passage of normal stools in abnormal places; same as soiling?

Cause is often psychological/behavioural

Question 13

Organic disease causes of constipation?

Answer 13

Rare but consider if the onset is from early infancy or refractory to treatment:
• Hirschsprung's 
• Metabolic (thyroid)
• Coeliac disease
• Anorectal abnormalities
• Neuromuscular

Question 14

Red flag sign in constipation?

Answer 14

Delay in passage of meconium >24 hours after birth

Question 15

Causes of abdominal pain?

Answer 15

Often no serious underlying cause but cannot miss:
• Coeliac disease
• IBD (bloody diarrhoea, malnutrition, etc)
• Malrotation and intermittent volvulus (bile-stained vomit, etc)

Question 16

Concerning features with abdominal pain?

Answer 16

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

Question 17

Relationship between functional abdominal pain and anxiety?

Answer 17

If a child has functional abdominal pain, they are more likely to develop anxiety disorder as an adult

Question 18

Concerning features with headaches?

Answer 18

• Headache on waking
• Worse with coughing/bending
• Associated vomiting, esp. in the morning
• Visual disturbance
• Gait disturbance
• Cranial nerve palsy

Question 19

Median symptoms interval time (time between symptoms onset and diagnosis) for childhood brain tumours is approximately?

Answer 19

2.5-3 months

Question 20

Causes of “funny turns”?

Answer 20

Seizures

Breath-holding

Reflex anoxic seizures

Benign neonatal sleep myoclonus

Night terrors

Gratification disorder

Faints

Cardiac

ALTE

Question 21

Red flag signs for cardiac syncope in children?

Answer 21

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

Question 22

Associated symptoms that may occur with heart murmurs?

Answer 22

Breathless and blue

Pale

Sweaty

Poor feeding

Question 23

Characteristics of innocent murmurs?

Answer 23

Systolic and low intensity:
• 2nd left interspace
• Medial to apex
• Beneath either clavicle (may be continuous- ‘venous hum’ –disappears when supine)

Question 24

Red flag signs with heart murmurs?

Answer 24

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

Question 25

Potential causes of a heart murmur?

Answer 25

Ventricular-septal defect

Atrial-septal defect

Patent ductus arteriosus

Question 26

Commonest heart murmur in childhood?

Answer 26

Innocent heart murmur

Question 27

Differences between food allergy and food intolerance?

Answer 27

Food allergy - type 1 IgE mediated acute allergic reaction; can cause anaphylaxis

Food intolerance - delayed reaction; symptoms are more varies and mechanism is unclear

Question 28

Minor abnormalities that present in infants?

Answer 28

Head shape and size

Skin lesions

Feeding concerns

Crying excessively

Question 29

Concerning features in infants?

Answer 29

Abnormal growth (weight and OFC - head circumference)

Concerns about development

Symptoms in infants are non-specific (low index of suspicion)

Question 30

Clinical features that increase the likelihood of the diagnosis being asthma?

Answer 30

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

Question 31

Other features that suggest symptoms are asthma-related?

Answer 31

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