Paeds: Spot Diagnosis Flashcards

1
Q

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
A

Intussusception:

  • Cause: telescoping (usually when transitioning to solids)
  • Diagnosis: USS or barium bowel enema
  • Treatment: Air enema. If that fails, laparotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Jaundice on eating fava beans/during infection

- what three cell types/bodies may be present on blood film?

A

G6PD deficiency

Heinz bodies, hemighosts and bite cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Asymptomatic when younger; Fixed and widely split S2; Ejection Systolic murmur in pulmonary area

A

ASD.

Types: Ostium Secundum, Ostium Primum, Sinus Venosus ASD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Preterm baby; Poor feeding, failure to thrive, tachypnoea; Active precordium, thrill, Gallop rhythm; Classical continuous machinery murmur pulmonary area
Hepatomegaly,oedema

A

PDA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A

VSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Trisomy 21; Poor feeding ,failure to thrive, tachypnoea; Active precordium ,Thrill ,Gallop rhythm; Hepatomegaly, oedema; Murmur due to valve regurgitation

A

AVSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

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

A

CoA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Weak Pulses; Thrill palpable in suprasternal region and carotid area; Ejection systolic murmur in aortic area; If critical, then child presents collapsed and acidotic

A

Aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

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?

A

Shunt reversal causing Eisenmenger’s complex. Often fatal in pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

a) NEC
b) HUS
c) Fissure
d) Sexual abuse
e) Volvulus
f) Intussusception
g) HSP; intussusception may coexist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Classic triad:
Microangiopathic haemolytic anaemia (Coombs’ test negative).
Thrombocytopenia.
Acute kidney injury (acute renal failure)

A

HUS - caused by E. Coli 0157

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bilious vomiting in an infant = _____ until proven otherwise

Rx?

A

Volvulus.

Ladd’s procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

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?

A

Pyloric stenosis.

Pyloromyotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In patient with HD: abdominal pain, fever, and foul-smelling and possibly bloody diarrhoea, with vomiting.
Rx?

A

Enterocolitis

IV fluids and broad-spectrum ABx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Failure to pass meconium in first 48 hours - 2 main diagnoses

A

CF, HD

17
Q

FTT, wasted buttocks, iron/folate/B12 deficiency

A

Coeliac

18
Q

Acute abdomen, confusion, dehydration.
DEFG
Ix to confirm? (triad)
Rx?

A

DKA
Venous gas: Met acidosis; ketonaemia, ketonuria
IV fluids and KCl. After > 1h, add insulin until BM 12-15, then swap for glucose 5%.

19
Q

Abnormalities in communication and reciprocal social interaction, and repetitive, restricted or stereotyped behaviour that manifests by age 3.

A

Autism spectrum disorder

20
Q

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

A

Rett syndrome

21
Q

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.

A

Sepsis (probably Group A strep)

22
Q

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

A

Bronchiolitis

23
Q

A one year old child develops fevers, a high-pitched cry and lethargy over an eight hour period. He progressively becomes less responsive.

A

Meningitis? Meningococcal disease?

24
Q

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?

A

TGA

Balloon atrial septostomy

25
Q

Blueberry muffin baby

- 3 differentials

A

Rubella, neuroblastoma, congenital leukaemia, CMV

26
Q

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.

A

Neuroblastoma

27
Q

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?

A

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

28
Q

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
A

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)
29
Q

Cyanosis and sudden collapse on day 2

A

TGA

30
Q

Cyanosis on exercise/ feeding, child squats to relieve these

A

Tetralogy of Fallot

31
Q

Child with stridor, drooling, unable to speak (or hot potato voice), sitting immobile and mouth open in tripod position
- Management?

A

Acute epiglottitis

Call anaesthetics to intubate, DON’T examine throat, IV cefuroxime