Paediatric Histories Flashcards

1
Q

What additional areas are important in a paediatric history?

A

Pregnancy and birth
Feeding
Development
Immunisations

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2
Q

What red flags should you ask about in a paediatric vomiting history?

A
Projectile vomiting
<50% feeds taken
No wet nappies
Non-blanching rash
Symptoms of UTI
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3
Q

What traffic light system questions can you ask in a paediatric history? (5*)

A

Colour: look paler than normal?
Hydration: feeding/drinking, wet nappies
Activity: playing as normal or more tired?
Respiratory & rashes: any difficulties? rashes?
Temperatures: felt hot/recorded temps

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4
Q

What are the differential diagnoses for paediatric vomiting? (6)

A
GORD
Pyloric stenosis
Interssusception
Coeliac disease
Meningitis
Gastroenteritis
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5
Q

What is the presentation of GORD in a vomiting child?

A

Common in 1st year: immature LOS
Recurrent regurg and vomiting related to feeds
Distressed after feeds
RFs: Prem delivery & CP

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6
Q

What is the presentation of pyloric stenosis in a vomiting child?

A

Peak age: 2-7 weeks
Projectile vomiting straight after feed
Child remains hungry
Complications: dehydration, constipation and FTT

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7
Q

What is the presentation of interssusception in a vomiting child?

A

Peak age: 5-10 months
Paroxysmal colicky pain every 10-20 mins
Early: vomiting, bile stained
Late: Mucus and blood per rectum

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8
Q

What is the presentation of coeliac disease in a vomiting child?

A

Peak age: 9 months-3 years (after weaning)

Vomiting, pallor, steatorrhoea, abdo distension & FTT

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9
Q

What is the presentation of meningitis in a vomiting child?

A
Vomiting - won't take feeds
Fever, irritable or lethargic
Non-blanching purpuric rash
Cold extremities
Signs of raised ICP
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10
Q

What is the presentation of gastroenteritis in a vomiting child?

A

Diarrhoea and vomiting
Fever, irritable, unwell
Hx of recent travel
Someone else has similar problems

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11
Q

What red flags should you ask about in a paediatric failure to thrive history? (3)

A

Chronic diarrhoea
Developmental delay
Regression (inc weight loss)

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12
Q

What specific FH should you ask about in a paediatric failure to thrive history? (3)

A

Coeliac disease
Cystic fibrosis
Diabetes

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13
Q

What are the organic differential diagnoses for paediatric failure to thrive? (4)

A

Prenatal
Intake issues
Malabsorption
Metabolic disorders

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14
Q

What are the prenatal causes of failure to thrive? (5)

A
Prematurity
Maternal malnutrition
Congenital infections
Toxin exposure in-utero
Intrauterine growth restriction
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15
Q

What are the intake issues that cause of failure to thrive? (4)

A

Neuromuscular disorders = inability to suck/swallow (e.g. Cerebral palsy)
Cleft pallet
Long standing GORD/vomiting after feeds

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16
Q

What are the malabsorption causes of failure to thrive? (5)

A
IBD
Coeliac
Cows milk intolerance
Cystic fibrosis
Chronic diarrhoea
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17
Q

What are the metabolic disorders that cause of failure to thrive? (5)

A
Poor metabolism: 
- Hypothyroidism, 
- Diabetes
Increased metabolic demand: 
- Hyperthyroidism, 
- Heart failure
- Renal failure
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18
Q

What are the non-organic differential diagnoses for paediatric failure to thrive? (2)

A

Constitutional delay

Inadequate feeding

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19
Q

What red flags should you ask about in a paediatric convulsions history? (5)

A
Seizure lasting >15 mins
Focal seizure
Recurrent within same illness
Otorrhoea
Suspected meningitis
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20
Q

What differential diagnoses should you consider in a paediatric convulsions history? (5)

A
Febrile convulsions
Reflex anoxic attack
Breath holding attack
Epilepsy
Meningitis
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21
Q

What features would make you think of febrile convulsions in a convulsing child?

A

Age: 6 months - 5 years
High temp >38 at time of seizure, usually viral
Tonic and/or clonic, symmetrical, generalised seizure. Lasts <5 mins
No signs of CNS infection, focal neuro signs, or previous Hx of epilepsy

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22
Q

What features would make you think of reflex anoxic attacks in a convulsing child?

A
Triggered by fear, anxiety or pain
Brief and spontaneous 
Lasts <1 min
Pale and limp, briefly LoC, followed by involuntary tonic and/or clonic movements of limbs
May have urinary incontinence
Feels groggy after
No tongue biting
23
Q

What features would make you think of breath holding attack in a convulsing child?

A

Precipitated by emotion: anger, frustration, trauma
Crying episode
Breath held and pallor/cyanosis develops
LoC may occur

24
Q

What features would make you think of epilepsy in a convulsing child?

A

RF: birth asphyxia, CP, trauma
Precipitants: TV, lack of sleep
Partial/generalised/absent

25
What features would make you think of meningitis in a convulsing child?
Unwell and drowsy child prior to convulsions with pyrexia | Non-blanching rash may be present
26
What should you consider if a convulsing child has a discharging ear?
Intracranial complications of otitis media
27
What red flags should you ask in a child with developmental delay? (7)
``` Loss of skill at any age Not fixing or following Can't sit unsupported at 12 months No speech by 18 months Not standing by 18 months Persistent toe walking Loss of hearing ```
28
What differential diagnoses should you consider in a child with delayed motor development? (5)
``` Normal variation Cerebral palsy Duchenne muscular dystrophy Metabolic: rickets, hypoglycaemia Environmental: e.g. bed-bound ```
29
What differential diagnoses should you consider in a child with delayed speech and language development? (6)
``` Normal variation Hearing difficulties e.g. OM with effusion Autism spectrum disorder Cleft palate Learning difficulties Environmental deprivation/neglect ```
30
What red flags should you ask in a child with pyrexia? (5)
``` Neck stiffness/photophobia Non-blanching rash Foreign travel Drenching night sweats Bruising/bleeding tendency ```
31
What questions should you ask in a systems review of a child with pyrexia? (7 areas)
Haematological: bleeding/bruising, recurrent infections, TATT Chest: cough, wheeze, added sounds to breathing, sputum, chest pain ENT: runny nose, sore throat, earache/discharge, change in hearing GI: tummy ache, D/V GU: burning pain on urination NS: headache, neck siffness, rash Constitutional: travel, bites, growth, weight loss
32
What differential diagnoses should you consider in a child with pyrexia? (10)
``` Meningitis URTI UTI Bronchiolitis Croup Kawasaki's disease Otitis media Tonsilitis Pneumonia Epiglotitis ```
33
What features would make you think of URTI in a child with pyrexia?
Coryzal symptoms | May develop earache + otitis media secondary to URTI
34
What features would make you think of meningitis in a convulsing child?
Unwell child, irritable, drowsy, headache, photophobia, weak/high pitched cry Non blanching rash and seizures Can present non-specifically
35
What features would make you think of UTI in a convulsing child?
Abdo pain Dysuria, strong smelling urine Irritability, poor feeding
36
What features would make you think of bronchiolitis in a convulsing child?
Common in 1st year Raspy cough, wheeze, coryzal Sx, fever Less wet nappies, poor feeding, grunting = severe infection
37
What features would make you think of croup in a convulsing child?
Viral illness causing barking cough + stridor and coryzal Sx Commonest in 1st few years Usually self limiting, worse at night Can cause airway obstruction
38
What features would make you think of Kawasaki's in a convulsing child?
Fever >5 days and four of: 1. Injected pharynx/ Cracked lips/ Strawberry tougue 2. Conjunctival infection 3. Change in extremities 4. Polymorphous rash 5. Cervical lymphadenopathy
39
What features would make you think of tonsillitis in a convulsing child?
``` Sore throat + fever CENTOR: Cough absent Exudate Nodes (Tender ant cervical) Temp >38 Age: 3-14 ```
40
What features would make you think of otitis media in a convulsing child?
Otalgia | Decreased hearing
41
What features would make you think of pneumonia in a convulsing child?
Productive cough, fever, unwell with grunting sounds
42
What features would make you think of epiglotitis in a convulsing child?
Drooling, unwell, soft stridor, severe sore throat, not had Hib vaccination
43
How do you manage URTI in a child?
``` Most self limiting Patental advice: - Monitor temp - Paracetamol - Fluids ```
44
How do you manage meningitis in a child?
Community: urgent 999 admission + IM benzylpenicillin Hospital: - >3 months: ceftriaxone, - <3 months: cefatoximine + amoxicillin/ampicillin
45
How do you manage croup in a child?
Single dose of dexamethasone + admit if respiratory distress
46
What red flags should you ask in a child with behavioural issues? (4)
Developmental delay No symbolic play by 2y No interactive play by 3y Lack of meaningful speech in short sentences by 3y
47
What questions should you ask about environment for a child with behavioural issues?
How are they at home/school/social? Are they the same at school/home? Can you take them to public places?
48
What features of ADHD should you ask in a child with behavioural issues? (3)
Hyperactivity: restless, fidgety, constantly talking? Impulsiveness: takes turns, interrupts conversations? Inattention: concentration, distracted?
49
What features of autism spectrum disorder would you ask in a child with behavioural issues? (3)
Communication difficulties Social impairment: friends, play with others, imaginary play Repetitive behaviour: strict routines, what happens if its changed
50
What features would make you think of ADHD in a child with behavioural issues?
``` Age range: 3-7 Inattention Hyperactivity Impulsiveness Symptoms present >6 months across >=2 environments ```
51
What features would make you think of conduct disorder in a child with behavioural issues?
Age range: >7 Violence, bullying, theft, vandalism, cruelty to animals Problems at school, truancy, expulsion Disobedience, lack of respect for authority Precipitated by bullying, abuse, situation at home, parental addiction, family conflict
52
What features would make you think of ASD in a child with behavioural issues?
Social impairment Communication Repetitive behaviour RF: gestational age <35 weeks, FH, chromosomal disorders, CP
53
What differential diagnoses should you consider in a child with behavioural issues? (6)
``` ADHD ASD Conduct disorder/opositional defiant disorder Hearing/visual impairment Learning difficulties Tic disorder ```