Paediatrics Flashcards
1
Q
What are some differential diagnoses for Purpura in a child? What are some relevant questions you should ask?
A
Main DDx:
- HSP - henoch Scholein Pupura
- Viral Exanthem
- Streptococcal sepsis
Rule out:
- meningitis - non-blanching, neck stiffness, photophobia
- Kawasaki’s - strawberry tongue, conjunctivitis, lyphadenopathy
- anaphylaxis - angioedema, diffuse rash, shock
- viral exanthems (roseola, coxsackie, parvovirus, HSV, molluscum)
- ITP - blurred vision (low platelet count), blood in urine/stools
Ask:
- VACCINATION Hx
2
Q
What questions can you ask in a heads check? Give 2 for each category?
A
Home:
- who lives with you at home?
- is there someone you can chat to if you are stressed?
Education/Employment:
- whats school like?
- is school a safe place?
- what are your future study/employment plans?
Eating:
- does your body shape stress you?
- have you ever tried going on a diet or altering the way you eat?
Activities:
- what do you do for fun?
- how many hours of screen time do you get?
Drugs?
- any of your friends or family use tobacco? alcohol?
- have you ever used some? (CAGE)
Sexuality?
- attracted to anyone? interested in boys/girls?
- what does the term ‘safer sex’ mean to you?
Suicide?
- do you feel stressed or down more than usual?
- thought about hurting yourself?
Safety?
- ever seriously injured?
- drunk driving?
- met anyone online?
3
Q
Talk through the steps to a surgical abdominal examination in a child, what are you looking for?
A
- HELP
- HI - introduce, consent, explain, wash hands
- E - exopsure
- L - lighting
- P - positioning
- general inspection
- close inspection - point to where the pain is worst, cough/flex neck.
- ausculatation
- percussion (‘do you play the drums?’
- light palpation/deep palpation (feet towards bottom to relax muscles, talk while palpating
- McBurney’s point,
- Rosvings,
- Psoas (raise right leg against pressure or roll onto left and extend)
- Obturator sign (flex then internally rotate at hip)
- liver and spleen (palpation, percussion) and kidneys
- shifting dullness if distended
- lymph nodes
- vitals and hydration (pulse, RR, temp, sunken eyes, fontanelles, conjunctival pallor)
- DRE - inguinoscrotal exam and resp. (pneumonia/mesenteric adenitis)
4
Q
What are some differentials for a febrile convulsion?
A
- FC
- 6mths- 6 years - temp more susceptible to fit
- tonic clonic, last several minutes - time it. call ambulance if >5mins, child >1hr to recover, focal symptoms. See GP <5mins.
- no increased risk of developing epilepsy
- treat with panadol - doesn’t fix the FC though
- breath holding spells
- can happen after minor accident, fright, frustrated, or upset
- turn red then blue (can go pale) - may have a fit or twitch.
- 1-2 year old toddlers, grow out of it by 6.
- not harmful, Mg similar to FC.
- do not punish them for it or make a big fuss.
- see doctor if you’re having frequent attacks
- reflex anoxic seizure (vaso-vagal)
- epilepsy
- precipitators - hypoglycemia, head trauma, meningitis
- mimics:
- jerks in sleep
- tantrum
- parasomnia (sleepwalking)
- psychogeni
5
Q
What things should you always do in an Asthma history?
A
- Type:
- episodic (symptom free period)
- frequenct - viral infection triggers, need pred
- infrequent
- persistent (has symptoms all the time) - preventer
- nocturnal cough
- episodic (symptom free period)
- definition:
- <1year = bronchiolitis
- 1-2 years = viral induced wheeze
- >2 = virus + wheeze responds to ventolin = asthma (>1 attack but with atopy, eczema = diagnosis)
- no ventolin response = viral pneumonitis (give roxythromycin and pred)
- >4 do spirometry
- Action plan
- reliever medications (ventolin/bricanyl (if teenagers don’t want big one)
- pred for acute exacerbations if needed (frequent episodic)
- instructions for sport
- factsheet, read up on it
- Instructions on how to give:
- mask
- no mask 5+
- wash 1x a week if regular, soapy dish water no rinse
- Prevention:
- fluvax
- smoking
- triggers
- hospital care - 6 every 20minutes (3 rounds in an hour), 12 for >6years.
6
Q
What is the initial management and investigations for asthma?
A
- OSHIT MAN (acute)
- oxygen
- salbutamol
- hydrocortisone (predisolone)
- ipratropium
- theophylline (aminophylline)
- magnesium sulphate
- 6 puffs if <6 years 12 puffs if >6years
- mild 1 after 20mins, pred no response,
- moderate (O2 <92%), burst 1 dose every 20mins for 1 hour (review), prednisolone for 1-2 days.
- severe - as above but ipratropium, MgSO4, aminophylline, IV salbutamol, intubate
- discharge on regular pred, SABA and follow-up.
7
Q
What is relevant to a paediatric cardiovascular examination?
A
- HELP
- ask for vitals and growth chart (FTT)
- general inspection:
- well/unwell
- cyanosis - oedema, respiratory effort)
- hands (pallor, cap refill)
- pulse (radial, femoral, character) and delay (radio-radial, radiofemoral)
- eyes - pallor/jaundice, mouth (high arch/cyanosis)
- carotid pulse
- close inspection of the chest
- capillary refill
- heaves/thrills
- ausculatation - 4 areas and back + manoeuvres (inspiration/expiration, radiation to neck/axilla, lying on side, leaning forward)
- Loud P2 = pulmonary HTN
- fixed splitting = ASD
- clicks after S1: apex = ASD or bicuspid aortic, LSE + PS
- auscultate lung bases, peripheral oedema, pedal pulses
8
Q
What are some innocent murmurs?
A
- Still’s murmur
- short, mid systolic vibratory
- mid-left sternal edge - soft when standing loud when supine
- pulmonary flow murmur
- soft, blowing ejection murmur in pulmonary area radiating to the axilla
- carotid bruit
- rough ejection systolic murmur at carotid
- venous hum - continous at sternoclavicular junction,
9
Q
What are some pathological murmur features?
A
- diastolic
- pansystolic
- late systolic
- harsh/high pitched, split S2
- symptomatic
10
Q
Talk through ASD, VSD and TOP.
A
- VSD
- large - LHF, soft systolic murmur, apical diastolic
- small - pnasystolic LSE, harsh/high pitched
- PDA
- continous with no variation with posture
- LHF if severe
- TOF
- appears late in infancy, clubbing, harsh ESM (LSE or pulmonary), radiating to the back, hypoxic tet spells.
11
Q
A teenager is having seizures recently, having been diagnosed with epilepsy as a child. What should you include in history?
A
- consider types:
- focal
- simple (movements, tingling, numbness, hearing/smell)
- complex (clumsy actions, automatisms (chewing/swallowing/picking)
- generalised (tonic clonic, urinary, tongue)
- provoked/unprovoked
- focal
- predisposing
- stress (HEEADSSS
- sleep deprivation
- medication compliance
- alcohol
- illicit drugs
- hypoglycemia
- fever
- Counsel
- triggers:
- lights/sleep deprivation
- driving/swimming/heavy machinery
- seizure diary
- prescription and aim of medication
- inform school/childcare/clubs
- call ambulance if >5mins, LOC afterwards, injury
- any questions - pamphlet
- triggers:
- DIAMOCAP (Dx, Ix, Admissions, Mg, complications, prognosis)
- Other:
- ketogenic diet
- vagus nerve stimulation
- epilepsy surgery
12
Q
Talk through the respiratory examination.
A
- HELP
- inspection
- WOB - nasal flare, tracheal tug, head bobbing, abdo excursion, sub/inter-costal recession, suprasternal retraction, noises
- hands (cap refill, nails, palms)
- vitals
- eyes
- tracheal deviation
- close inspection of chest (symmetry, expansion)
- pecrussion, auscultation, fremitus
- lymph nodes
‘I would also like to do peak flow, O2 sats, an ENT, CVD and hepatomegaly exam’
13
Q
How can you rank asthma severity?
A
- mild - normal, no increase WOB, talks
- moderate - increased WOB, accessory muscles, tachycardia, limitation of speech
- severe - marked WOB, limitation of speech, distressed
- critical - drowsy, maximal, silent chest, unable to talk, exhaustion
14
Q
What questions would you ask for a child who has neonatal jaundice?
A
- types:
- unconjugated
- physiological - after 24 hours improves at 2 weeks
- hemolytic (rhesus or G6PD deficiency)
- non-hemolytic - cephalohematoma, hypothyroid
- conjugated
- intrahepatic (infection, genetic, drugs)
- post-hepatic - Biliary atresia, GIT obstruction
- unconjugated
- Confirm age, characterise jaundice (timecourse)
- kernicterus symptoms:
- phase 1 - lethagy, poor feeding, hypotonia (reversible)
- phase 2 - fever, hypertonia, back arching
- phase 3 - athetosis (writhing movements - irreversible)
- LT - upward gaze palsy, sensorineural deafness, CP
- Hx:
- antenatal
- isoimmunization
- TORCH
- TFT
- polycythaemia (DM/TTTS)
- perinatal
- infections
- PROM
- Instrumental
- delayed cord clamping
- Post-natal
- newborn screen
- feeding
- drugs
- FHx
- antenatal
- DDx:
- sepsis
- post-hepatic (pale stool, dark urine)
- Tx:
- 60% newborn babies within 1 week of life.
- phototherapy - fluid, hydration, weight, electrolytes
- Bhutani nomogram (phototherapy vs exchange transfusion)
15
Q
What are some differentials for a vomiting child? What features would each have?
A
- gastroenteritis:
- diarrhoea, contacts, food, travel
- mesenteric adenitis
- pain, abdo tender, fever, malaise, flu-like
- appendicitis
- 10-12y.o. abdo pain >4 hours, diarrhoea, lies still
- intussusception
- 3mth-3year old, red current jelly, lethargy, pallor, colic (legs drawn up)
- Malrotation with volvulus
- bile stained vomit, feeding, late - PR bleed, distension, tenderness
- Pyloric stenosis
- Septicemia (UTI, pneumonia, meningitis)
- Testicular torsion
