Paeds Differential Presentations Flashcards
1
Q
What is toddler diarrhoea?
A
- Most frequent cause of chronic diarrhoea in children aged 1-5
- Children DO NOT appear unwell
- Does not affect their ability to thrive
- Usually resolves by school age
- Theories of cause inc fast gut transit time
2
Q
Conservative management for toddler diarrhoea
A
Four F’s
* Fat
* Fibre
* No fruit juices
* Fluids
3
Q
Differentials for toddler diarrhoea
A
- Infection
- IBD
- Coeliac
- Dietary intolerance
4
Q
Toddler diarrhoea vs infection
A
- Infection is acute, TD chronic
- Fever
- Abdominal pain
- Vomitting
- Other close contacts unwell
- Can have bloody stool
- Stool culture shows organism causing infection
5
Q
TD vs dietary intolerance
A
- DI has pattern - associated with specific food triggers
- Abdominal cramps
- Increased flatulence
- Sometimes get skin reactions
- Elimination diets help - try lactose first as most common
6
Q
TD vs IBD
A
- IBD abdominal pain
- Blood/mucus in stool
- Both chronic
- Faecal calprotectin for IBD and biopsy needed for diagnosis
- Weight loss/deficiencies?
7
Q
TD vs Coeliac disease
A
- Coeliac abdo pain and distension
- N+V sometimes
- Failure to thrive, malnourished so anaemic, short stature, wasted gluteal muscle bulk, easy bruising (vit K)
- Serology needed for Anti-TTG
- OGD with biopsy
8
Q
GORD in younger children presents with
A
- Refusing feeds
- Gagging/choking
- Faltering growth
- Recurrent otitis media or sometimes dental erosions
- Typically occurs under 8 weeks
9
Q
Posseting vs GORD
A
- Possetting is normal, occurs after big feeds or if jiggled around following feeds
- Just some regurge of milk
- Child will not be distressed - will be distressed with GORD
10
Q
RF for GORD
A
- Premature
- Neurological disorders
11
Q
Conservative management of GORD
A
- Lie at 30 least at degrees following feeds
- Don’t lie down 30-45 mins after feeds
- Burping- try different positions, try to get 2nd burp
- Feed little and often - avoid large feeds
12
Q
Medication management of GORD
A
- Thickening agents eg cornstarch, rice starch, carob bean gum, locust bean gum
- Gaviscon in milk/supplement alongside milk with hotwater
- Metoclopramide
- Children aged 1-2 can do trial of omeprazole/H2 receptor antagonist, if symptoms persist –> specialist
13
Q
Differentials for GORD
A
- Psychological - bulimia in older children
- Abdominal migraine
- Mesenteric adenitis
14
Q
Bulimia vs GORD
A
- Mood changes
- Critical of weight
- More severe reflux symptoms as acid goes further up oesophagus
- Both will have vomitting/sore throat
15
Q
Abdominal migraine vs GORD
A
- In children migraines primarily affect abdomen
- Both have central abdominal pain, N&V
- Migraines can have associated headaches, photophobia, migraine triggers (eg food, stress), episodic pain, aura
16
Q
What is mesenteric adenitis?
A
- Inflamed abdominal lymph nodes
- Common in under 16s
- Secondary to viral infection
- Self limiting
17
Q
Mesenteric adentitis vs GORD
A
- Associated URTI
- Abdo pain often RIF
- Fever, diarrhoea
- Enlarged lymph nodes on USS
18
Q
Is wheeze common in children with LRTI?
A
- YES
- They get inflammation of bronchi = narrowing airways = wheeze
- Endothelium also becomes leaky and increased fluid enters airways = wheezy
- So be cautious diagnosing asthma in children
19
Q
Management of viral wheeze
A
- Assess using NICE traffic light sustem and own clinical judgement
- Low risk –> SABA and spacer at home (10 puffs equivalent to nebuliser), short course steroids if asthmatic, safety net and review in 48hrs
- High risk/intermediate –> admit, nebs salbutamolm high flow O2 if needed
20
Q
Differentials for viral wheeze
A
- Asthma
- Bacterial respiratory infection
- Inhaled foreign body
21
Q
Asthma vs viral wheeze
A
- Triggered by asthma triggers eg cold air, dust etc
- Recurrent and episodic (vs triggered by virus)
- No fever
- Dry cough
- History of atopy
22
Q
Viral wheeze vs bacterial infection
A
- Both have wheeze
- Wheeze can persist until infection treated
- Fever common
- Productive cough
- More specific signs on examination eg crackles etc
23
Q
Foreign body vs viral wheeze
A
- History of choking/ingesting foreign body
- Dry coughing for weeks - long term sometimes or can be acute
- Easily confused with asthma if long term
- Collateral history important
- Need to go A&E for CXR
24
Q
What is Osgood Schlatter disease?
A
- Inflammation at tibial tuberosity - tender here and swollen (just below patella tendon insertion)
- Gradual onset
- Unilateral - can be bilateral
- Relieved by rest
- Made worse kneeling, jumping, running etc
- Typically adolescents who are active
- Most cases resolve by themselves
25
Treatment Osgood Schlatters
* Rest
* Ice
* OTC medications eg paracetamol and NSAIDs
* Protective knee pads if kneeling
* If not respond to this, consider physio referral/reasses cause with paeds/ortho referral
26
Differentials for Osgood Schlatters disease
* Injury
* Perthes
* SUFE - slipped upper femoral epiphysis
27
OS vs injury
* History of trauma
* Variable exam findings eg unable to weight bear
* Sudden onset
28
OS vs Perthes
* Perthes = referred pain from hip
* Get associated hip pain and restricted movements of hip - gives strained muscle like pain in hip
* Caused by avascular necrosis of femoral head epiphysis - femoral head disintegrates
* Tender to palpate hip too
29
OS vs SUFE
* Referred pain from hip
* Due to femoral head slipping on femoral epiphysis (growth plate)
* Still have smooth hip joint but shaft has come away from femoral head
* Strained muscle like pain in hip similar to Perthes
30
Other differentials for OS
* Patellar tendonitis
* Chondromalacia patella
* Osteochondritis dissicans - pain/swelling after exercise, distal femur has poor blood supply, becomes flattened
* Patellar subluxation - patella moves out of indentation on femur, pop back in
* Growing pains
31
What is threadworm?
* Parasitic infection of worms
* Infect human gut
* Transmission is fecal oral - scratch itchy perianal area, ingest eggs
* Spreads to household contacts too
* Intense perianal itching, worse at night
32
Diagnosis of threadworms
* Good history
* Visible worms in stool/around perianal area
* Can do scotch tape test and observe under microscope - rarely done tbf
33
Treatment for threadworms
* Treat patient and whole household once and then 2 weeks later
* Good hygiene measures between - hot wash sheets, towels, bedding clothes etc
* Mebendazole for children over 6 months and adults
* If pregnant, breastfeeding or under 6 months - just hygiene
34
Threadworms vs candida
* Candida more associated with vulva/genital itching than threadworms
* White, cottage cheese discharge
* More common children with weaker immune system eg HIV, cancer, diabetes or immunosuppressant drugs
* Could have oral thrush too
* Red genital area
35
What is infantile colic?
* Occurs within first few weeks of life
* Settles by 3-5 months
* Characterised by recurrent crying - worse in afternoons and evenings for prolonged periods of time
* Lift legs up
* Could be caused by bowels not being fully developed - poor peristalsis so trapped gas and faeces
36
Treatment for colic
* Reassure parents benign
* Offer support - child is at increased risk of maltreatment
* Infacol or Colief drops can be tried
37
Advice for parents for babies with colic
* Hold/cuddle baby
* Wind baby after feeds
* Bath baby in warm water
* Feed baby as usual
* Gently rock baby
* Try white noise
38
Complications colic
* Parental stress
* Parental sleep deprivation
* Premature cessation of breastfeeding/weaning
* Increased risk of maltreatment
39
Differentials for colic
* Reflux
* Intussusception
* Cow's milk protein allergy
* Pyloric stenosis
40
Colic vs reflux
* Refluc babies more irritable after feeds
* Spitting up contents of feeds
* Failure to gain weight sometimes in reflux
* Reflux - any time of day, colic in evenings/night
41
Colic vs intussusception
* Severe abdo pain
* Vomitting
* Change in stool consistency - currant jelly like
* More acute, serious, immediate attention needed
42
Colic vs CMPA
* GI symptoms
* Skin manifestations
* Resp symptons
* Overall atopy
* Can persist and occur at any age, colic resolves by 5 months
* Improvement seen if stop cows milk
43
Colic vs pyloric stenosis
* Feeding difficulties
* Projectile vomitting - from stomach filling and inability to empty
* Occurs very early on in life
* Weight loss can occur
44
