Paeds investigations Flashcards
What is a automated otoacoustic emission test (AOAE)
A newborn hearing test. It is not compulsory.
A small earpiece is placed in the babies ear and gentle clicking sounds are played.
In a lot of babies the first test does not always work very well.
What is the heel prick test ? When is it done and why? (5 things)
A blood test of the heel done on or by day 5 of being born (or day 8 is being transfused). It is done using a Guthrie card which is important for early detection of certain diseases.
E.g
- CF
- Congenital hypothyroidism
- Sickle cell
- Inherited metabolic disease (6 different types: one common one is =Phenyliketonuria)
- Severe combined immunodeficiency
What is an absolute indication for a CT head in a child? (6 things)
- GCS of <14 **
- Child <1
- Tense fontanelle
- Signs of base of skull fracture
- Focal neurological deficit
- Recurrent vomiting after a head injury
Which blood test has different normal values in children compared to adults?
- Hb
Due to bone marrow development and RBC development
What investigation should always be done for a child <5 years old with a fever? and why?
Blood MC&S (Blood culture)
- This is because you do not want to miss any type of sepsis
How would you investigate acute bronchiolitis ?
What would you look for when diagnosing it?
This is a clinical diagnosis.
Investigations would include general observations and chest auscultation to monitor any wheeze
To diagnose;
- Coryzal symptoms
- Cough
- Tachypnoea
- Chest recession
- Wheeze/crackles on auscultation
How would you investigate an acute limp in a child ?
- Rheumatological bloods ?
2.
How would you investigate febrile seizures in a child?
What investigations would you do if you were concerned about a septic child? (3 things)
You need to identify the source of the fever
- Blood culture
- Urine MC&S
- Stool?
Which liver investigation is usually higher in children and why ?
ALP -
Because this is also found in the bones which are developing in children and so their values will be higher.
Why would urea and creatinine values be lower in children?
because these values increase with muscle mass. It reaches an adult range at around 12 years old
How would you do a capillary blood gas? What values is it good for?
With a heel prick. It is the child alternative to ABG’s
It is good for pH and Co2 but not oxygen
If a child presents with viral gastroenteritis, when would you do a stool sample? (5 things)
- If there’s blood in the stool
- If they have had recent travel
- If their symptoms are not improving
- Worried about sepsis
- If you are going to give antibiotics
What are the symptoms of Scarlet fever (7 THINGS) and what is the first line investigation (1 THING)?
Symptoms: 1. Sore throat 2.Fever 3.Headache 4.Fatigue 5.Nausea 6.Vomiting 7. Blanching (sandpaper) rash on the trunk 12-48 hrs after initial symptoms RASH SPARING THE FOOT SOLES AND PALMS
Investigation:
1. Throat swab
What is an indication for doing an abdominal X-ray in a child ? (2 things)
Why are these X-rays not done willingly?
- They require a lot more radiation!
Indications:
- Looking for a perforation in the abdomen
- Reasons for abdominal distension
What would a ‘football sign’ on abdominal x-ray in a child indicate ?
Free air in the abdomen following a gut perforation
This is an emergency!
What is the first line for muscular dystrophies?
serum CK which will be raised
If you are worried about a child with an increased WOB who is becoming hypoxic and needing litres of oxygen. What is the first thing you need to do?
- Get the anaesthetist involved!!!!!
What are the signs of Meningism? (4 things) + 2 extra signs in children.
- Neck stiffness
- Headache
- Photophobia
- Often with nausea and vomiting
- Buldging fontanelle
- High pitched cry/ irritable
Note:
children don’t always present with these symptoms
If you are going to give a child IV fluids, what must you check? (3 things)
- Electrolytes
- Glucose
- Na+, K+ and creatinine
What are some ddx for a rash in a child? (8 things)
- Meningitis
- Clotting disorder
- Scarlet fever
- Viral infection
- ITP
- Leukaemia
- Lymphoma
- Pmeumonia
What is the first line antibiotic for sepsis in a child?
IV Ceftriaxone
or
Benzyl Pen PO
What is the most common type of limp in children?
An antalgic gait
- The child will hurry off of one leg to reduce the pain
What might cause a limp in a child <3 years old ?
- Fracture or soft tissue injury
2. Developmental dysplasia of the hip
What might cause a limp in a child aged 3-10 years old?
- Transient synovitis
- Fracture or soft tissue injury
- Perthes disease (e.g leg calf perthies)
What might cause a limp in a child aged 10-18 years ?
- Fracture or soft tissue injury
- SCFE
- Perthies disease
- Osgood schlatter disease
In testicular torsion, how soon does management need to occur?
within 6 hours
How would you investigate a developmental hip dysplasia in a child <6months and a child >6 months?
<6 months:
Ultrasound
> 6 months:
Pelvic X-ray (because the femoral head ossification centre has developed by this age)
What condition presents with grunting sounds and a cough with an elevated WCC in children? How would you investigate this?
- Bronchiolitis
- Ix with Nasal swab
First line investigation for testicular torsion?
Emergency hospital admission to urology or paediatric surgery
First line for Muscular dystrophies?
CK.
- This will be high
How would you manage bilious vomit in a child?
Refer to pads!
How would you investigate intussusception ? What is the gold standard in diagnosis? (4 things)
- FBC - may show neutrophilia
- U&Es - may reflect dehydration
- Abdominal X-ray - may show dilated gas-filled proximal bowel
- Ultrasound - may show doughnut or target sign *** investigation of choice
GOLD STANDARD:
- Barium enema
How would you investigate Volvulus ? What is the gold standard in diagnosis?
- Plain abdominal X-ray ** gold standard
In a child with pyloric stenosis what symptoms would you expect and what is the first line investigation?
Symptoms:
- Projectile vomiting (non- bilious)
- Dehydration
- Failure to thrive
Ix:
- ABG (will show metabolic alkalosis)
- USS
1st line (gold standard) Abdo USS
