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Final OSCEs > Paediatric Histories > Flashcards

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
Q

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

A

Unwell and drowsy child prior to convulsions with pyrexia

Non-blanching rash may be present

26
Q

What should you consider if a convulsing child has a discharging ear?

A

Intracranial complications of otitis media

27
Q

What red flags should you ask in a child with developmental delay? (7)

A 
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
Q

What differential diagnoses should you consider in a child with delayed motor development? (5)

A 
Normal variation
Cerebral palsy
Duchenne muscular dystrophy
Metabolic: rickets, hypoglycaemia
Environmental: e.g. bed-bound
29
Q

What differential diagnoses should you consider in a child with delayed speech and language development? (6)

A 
Normal variation
Hearing difficulties e.g. OM with effusion
Autism spectrum disorder
Cleft palate
Learning difficulties
Environmental deprivation/neglect
30
Q

What red flags should you ask in a child with pyrexia? (5)

A 
Neck stiffness/photophobia
Non-blanching rash
Foreign travel
Drenching night sweats
Bruising/bleeding tendency
31
Q

What questions should you ask in a systems review of a child with pyrexia? (7 areas)

A

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
Q

What differential diagnoses should you consider in a child with pyrexia? (10)

A 
Meningitis
URTI
UTI
Bronchiolitis
Croup
Kawasaki's disease
Otitis media
Tonsilitis
Pneumonia
Epiglotitis
33
Q

What features would make you think of URTI in a child with pyrexia?

A

Coryzal symptoms

May develop earache + otitis media secondary to URTI

34
Q

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

A

Unwell child, irritable, drowsy, headache, photophobia, weak/high pitched cry
Non blanching rash and seizures
Can present non-specifically

35
Q

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

A

Abdo pain
Dysuria, strong smelling urine
Irritability, poor feeding

36
Q

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

A

Common in 1st year
Raspy cough, wheeze, coryzal Sx, fever
Less wet nappies, poor feeding, grunting = severe infection

37
Q

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

A

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
Q

What features would make you think of Kawasaki’s in a convulsing child?

A

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
Q

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

A 
Sore throat + fever
CENTOR:
Cough absent
Exudate
Nodes (Tender ant cervical)
Temp >38
Age: 3-14
40
Q

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

A

Otalgia

Decreased hearing

41
Q

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

A

Productive cough, fever, unwell with grunting sounds

42
Q

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

A

Drooling, unwell, soft stridor, severe sore throat, not had Hib vaccination

43
Q

How do you manage URTI in a child?

A 
Most self limiting
Patental advice:
- Monitor temp
- Paracetamol
- Fluids
44
Q

How do you manage meningitis in a child?

A

Community: urgent 999 admission + IM benzylpenicillin
Hospital:
- >3 months: ceftriaxone,
- <3 months: cefatoximine + amoxicillin/ampicillin

45
Q

How do you manage croup in a child?

A

Single dose of dexamethasone + admit if respiratory distress

46
Q

What red flags should you ask in a child with behavioural issues? (4)

A

Developmental delay
No symbolic play by 2y
No interactive play by 3y
Lack of meaningful speech in short sentences by 3y

47
Q

What questions should you ask about environment for a child with behavioural issues?

A

How are they at home/school/social?
Are they the same at school/home?
Can you take them to public places?

48
Q

What features of ADHD should you ask in a child with behavioural issues? (3)

A

Hyperactivity: restless, fidgety, constantly talking?
Impulsiveness: takes turns, interrupts conversations?
Inattention: concentration, distracted?

49
Q

What features of autism spectrum disorder would you ask in a child with behavioural issues? (3)

A

Communication difficulties
Social impairment: friends, play with others, imaginary play
Repetitive behaviour: strict routines, what happens if its changed

50
Q

What features would make you think of ADHD in a child with behavioural issues?

A 
Age range: 3-7
Inattention
Hyperactivity
Impulsiveness
Symptoms present >6 months across >=2 environments
51
Q

What features would make you think of conduct disorder in a child with behavioural issues?

A

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
Q

What features would make you think of ASD in a child with behavioural issues?

A

Social impairment
Communication
Repetitive behaviour
RF: gestational age <35 weeks, FH, chromosomal disorders, CP

53
Q

What differential diagnoses should you consider in a child with behavioural issues? (6)

A 
ADHD
ASD
Conduct disorder/opositional defiant disorder
Hearing/visual impairment
Learning difficulties
Tic disorder

Final OSCEs (18 decks)

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