Paeds: Spot Diagnosis Flashcards
6 month old.
- Paroxysmal abdominal pain with inconsolable crying
- Early: vomiting, neuro symptoms, unwell child
- Later: redcurrant stool
- O/E: Sausage-shaped mass in RUQ
- USS: Donut/target lesion
Intussusception:
- Cause: telescoping (usually when transitioning to solids)
- Diagnosis: USS or barium bowel enema
- Treatment: Air enema. If that fails, laparotomy
Jaundice on eating fava beans/during infection
- what three cell types/bodies may be present on blood film?
G6PD deficiency
Heinz bodies, hemighosts and bite cells
Asymptomatic when younger; Fixed and widely split S2; Ejection Systolic murmur in pulmonary area
ASD.
Types: Ostium Secundum, Ostium Primum, Sinus Venosus ASD
Preterm baby; Poor feeding, failure to thrive, tachypnoea; Active precordium, thrill, Gallop rhythm; Classical continuous machinery murmur pulmonary area
Hepatomegaly,oedema
PDA
Poor feeding, failure to thrive, tachypnoea; Active precordium, Thrill, Gallop rhythm; Pan-systolic murmur best heard at LLSB transmits to upper sternal edge and axillae; Hepatomegaly ,oedema
VSD
Trisomy 21; Poor feeding ,failure to thrive, tachypnoea; Active precordium ,Thrill ,Gallop rhythm; Hepatomegaly, oedema; Murmur due to valve regurgitation
AVSD
Weak femoral pulses; Pre and post ductal difference in saturations (but only if duct is open); Discrepancy between upper limb and lower limb blood pressure
Older children murmur over back (after collaterals develop); If duct has closed/ is closing these babies present collapsed and acidotic
CoA
Weak Pulses; Thrill palpable in suprasternal region and carotid area; Ejection systolic murmur in aortic area; If critical, then child presents collapsed and acidotic
Aortic stenosis
A pregnant woman with a VSD reports fainting spells during pregnancy. She also experiencies VTE, hypovolemia, coughing up blood and preeclampsia. Her mortality during/after delivery is around 30-60%.
What has occurred?
Shunt reversal causing Eisenmenger’s complex. Often fatal in pregnancy.
Wheeze diagnoses:
a) Recurrent, cough worse at night
b) Coryzal, pre-school age
c) Poor feeding, cyanosis, weak peripheral pulses
d) Happy, present from birth
e) History of prematurity or ventilation
f) Recurrent bacterial infections (protracted bacterial bronchitis) and failure to thrive (FTT)
g) Persistent nasal discharge, otitis media, situs inversus
h) Vomiting and aspiration post-feed
i) Sudden onset, choking
a) Asthma
b) Viral-induced
c) Congenital HD
d) Tracheo/bronchomalacia
e) bronchopulmonary dysplasia
f) immunodeficiency/ CF
g) ciliary dyskinesia
h) GORD
i) Inhaled foreign body, anaphylaxis
PR bleeding in children.
a) Premature infant on day 10; not breastfed
b) Profuse diarrhoea that turns bloody 1 to 3 days later; history of fever but afebrile by admission; vomiting and abdo pain; recent farm visit
c) History of constipation; painful and bright red
d) Signs of neglect and suspicion of NAI
e) Bilious vomiting, pain and distention
f) Paroxysmal pain (every 10-20 minutes), inconsolable crying, early vomiting; later redcurrant stool
g) Previous URTI, rash on back of legs and buttocks, some joint swelling, abdo pain. (note: must also investigate for potential coincident…?)
a) NEC
b) HUS
c) Fissure
d) Sexual abuse
e) Volvulus
f) Intussusception
g) HSP; intussusception may coexist
Classic triad:
Microangiopathic haemolytic anaemia (Coombs’ test negative).
Thrombocytopenia.
Acute kidney injury (acute renal failure)
HUS - caused by E. Coli 0157
Bilious vomiting in an infant = _____ until proven otherwise
Rx?
Volvulus.
Ladd’s procedure
Infant at 6 weeks old, progressive post-feed vomiting, now projectile. FTT, absent bowel movements, lethargy, constant hunger, dehydrated.
O/E: olive-shaped mass
Rx?
Pyloric stenosis.
Pyloromyotomy
In patient with HD: abdominal pain, fever, and foul-smelling and possibly bloody diarrhoea, with vomiting.
Rx?
Enterocolitis
IV fluids and broad-spectrum ABx
Failure to pass meconium in first 48 hours - 2 main diagnoses
CF, HD
FTT, wasted buttocks, iron/folate/B12 deficiency
Coeliac
Acute abdomen, confusion, dehydration.
DEFG
Ix to confirm? (triad)
Rx?
DKA
Venous gas: Met acidosis; ketonaemia, ketonuria
IV fluids and KCl. After > 1h, add insulin until BM 12-15, then swap for glucose 5%.
Abnormalities in communication and reciprocal social interaction, and repetitive, restricted or stereotyped behaviour that manifests by age 3.
Autism spectrum disorder
Girl with gross motor developmental delay and hand-wringing. Rapid deterioration between age of 1 and 4 with ASD features, seizures and episodes of hyperventilation or breath-holding. Stabilising of condition between ages of 4 and 10 and then further deterioration from this point on. Often results in dystonias, kyphoscoliosis, growth restriction and breathing abnormalities
Rett syndrome
2 week old, Fever 24 hours at home, Not feeding well
Crying constantly when awake and waking less often for feeds, Temp 38.5, Pale, cool peripheries.
Sepsis (probably Group A strep)
4 month old, Recurrent cough and noisy breathing past 3 days, indrawing, RR 60, nasal flaring, alert, well perfused, Temp 37.8, Bilateral crackles and wheese
Bronchiolitis
A one year old child develops fevers, a high-pitched cry and lethargy over an eight hour period. He progressively becomes less responsive.
Meningitis? Meningococcal disease?
2 day old neonate presents with cyanosis and umbilical artery gas shows low oxygen of 2.0 kPa. A murmur of pulmonary stenosis is auscultated as well as a loud S2. On CXR, an egg on a string appearance is found.
What is performed as a lifesaving procedure?
TGA
Balloon atrial septostomy
Blueberry muffin baby
- 3 differentials
Rubella, neuroblastoma, congenital leukaemia, CMV
3 year old with loss of appetite, vomiting and abdominal distention.
On examination, a mass is felt in the abdomen and the patient appears to have ‘racoon eyes’. They also have feature of opsoclonus, myoclonus and ataxia.
Neuroblastoma
4 - 11 days after birth, presents with lethargy, irritability, poor feeding, tremors, seizures and a bulging fontanelle. Disseminated infection causes constitutional signs, such as shock, jaundice, gastrointestinal bleeding and purpura. 50-60% of those with disseminated infection develop a characteristic vesicular rash.
- Prevention?
Neonatal HSE
If HSV-2 infection diagnosed prior to delivery - CS
If at/after delivery - topical aciclovir to neonate’s eyes and possible IV aciclovir
Preterm baby, delivered by CS to a diabetic mother. Struggling to breathe very soon after birth with recessions, cyanosis and nasal flaring.
- Diagnosis?
- Appearance on CXR?
- Rx? SOS - CpAp
IRDS
Ground glass appearance
- Surfactant via ETT
- Oxygen (target sats: 91 - 95%)
- Supportive care: nutrition (NG feed), temperature, glucose and hydration control
- CPAP (non-invasive) or IPPV (invasive)
- Antibiotics to cover for infection (discontinue if cultures negative)
Cyanosis and sudden collapse on day 2
TGA
Cyanosis on exercise/ feeding, child squats to relieve these
Tetralogy of Fallot
Child with stridor, drooling, unable to speak (or hot potato voice), sitting immobile and mouth open in tripod position
- Management?
Acute epiglottitis
Call anaesthetics to intubate, DON’T examine throat, IV cefuroxime
