Paeds

Question 1

PC: Failure to thrive

Answer 1

Diet and appetite
Recent illness

Associated symptoms:

• Vomiting
• Irritability
• Fever
• CoBH
• Poor feeding

RFs during pregnancy:

• Smoking & alcohol
• Maternal co-morbidities
• Maternal medications

Question 2

PC: Developmental delay

Answer 2

Associated symptoms

• Vomiting
• Irritability
• Fever
• CoBH
• Poor feeding
• Poor sleep
• Rash

RFs during pregnancy:

• Smoking & alcohol
• Maternal co-morbidities
• Maternal medications

Question 3

PC: Abdo pain

Answer 3

Infectious contacts!
Previous episodes

Associated symptoms

• Vomiting
• Irritability
• Fever
• CoBH
• Poor feeding
• PR bleeding
• Anorexia

Question 4

PC: Jaundice

Breast milk jaundice (DDx: haemolysis)

Answer 4

Abdominal pain or distension
Dark urine or pale stool
Medications that have been tried

Infectious contacts
Previous episodes

Associated symptoms:

• Vomiting
• Irritability
• Fever
• CoBH
• Poor feeding

Breast milk jaundice:
- Commonest prolonged jaundice in children
- It is a benign process with no real identifiable cause
- 10% can remain jaundiced up to 1 month of age
Mx:
- Increase the number of feeds per day
- Interrupting feeds with formula
- Phototherapy if severe
Full recovery is expected

Question 5

PC: Seizures

Febrile seizure (DDx: childhood epilepsy if multiple episodes)

Answer 5

Before
During (nature of seizure, LOC, incontinence)
After (drowsiness)

Trigger

Infectious contacts
Previous episodes

Associated symptoms:

• Vomiting
• Irritability
• Fever
• CoBH
• Poor feeding

Febrile seizure:

• Seizures in response to illness
• They commonly occur between 6 months to 6 years
• 50% will go on to have further seizures during illness but the chance lessens with age
• Advise the parents to not try and restrain the child if they have a seizure but support their head and turn it to one side to avoid choking
• Call ambulance if the seizure >5mins or b2b seizures with no regaining of consciousness
• Paracetamol/Ibuprofen can be given if the child has a temperature
• 1% will develop epilepsy

Question 6

PC: Rash

Answer 6

About the rash:

• Distribution
• Description
• Discharge
• Itch
• Blanching
• Bleeding

Infectious contacts
Previous episodes

Associated symptoms:

• Vomiting
• Irritability
• Fever
• CoBH
• Poor feeding

MMR VACCINE!!

Question 7

PC: Cough

Answer 7

About cough:

• Frequency
• Dry or productive
• Amount and colour of sputum
• Haemoptysis
• Triggers

Infectious contacts
Previous episodes

Associated symptoms:

• Vomiting
• Irritability
• Fever
• CoBH
• Poor feeding
• Wheeze
• SOB
• Chest pain

Question 8

Systems review

AN/PN Hx (7)

Developmental Hx (2)

Social Hx (5)

Answer 8

Systems review:
CVS: sweating, cyanosis, pallor, SOB 
Resp: cough, wheeze
GI: appetite, pain, diet, vomiting
Neuro: headaches, fits/seizures 
MSK: limp, joint swelling, pain, rashes 

AN/PN Hx:

• Any abnormalities on scans or screening
• Any problems during pregnancy
• Vaginal or c-section?
• Spontaneous or induced/elective?
• Preterm or term?
• Birth weight
• Admission to NICU?

Developmental Hx:

• Normal height/weight for given age + head circumference
• Any delay or concerns with development?

Social Hx:

• Who else is at home
• Housing situation
• School
• Pre-morbid personality
• Smokers at home