Paeds spot diagnosis

Question 1

Focal neurological signs

Focal seizures

Decreased level of consciousness

Answer 1

Encephalitis

• viral cause, Herpes Simplex

Question 2

Tachypnoea (respiratory rate >60 breaths/minute, age 0–5 months; >50 breaths/minute, age 6–12 months; >40 breaths/minute, age >12 months)

Crackles in the chest

Nasal flaring

Chest indrawing

Cyanosis

Oxygen saturation ≤95%

Answer 2

Pneumonia

Question 3

Fever for more than 5 days and at least 4 of the following:

bilateral conjunctival injection

change in mucous membranes

change in the extremities

polymorphous rash

cervical lymphadenopathy

Answer 3

Kawasaki disease

Question 4

headache

photophobia

neck stiffness

positive kernig sign (pain on leg straightening)

Answer 4

meningitis (older children)

Question 5

Neck stiffness

Bulging fontanelle

Decreased level of consciousness

Convulsive status epilepticus

high-pitched cry

Answer 5

Bacterial meningitis (younger)

Question 6

Vomiting

Poor feeding

Lethargy

Irritability

Abdominal pain or tenderness

Urinary frequency or dysuria

Answer 6

UTI

Question 7

Swelling of a limb or joint

Not using an extremity

Non-weight bearing

Answer 7

Septic Arthritis

Question 8

Fever for more than 5 days and at least 4 of the following:

bilateral conjunctival injection

change in mucous membranes

change in the extremities

polymorphous rash

cervical lymphadenopathy

Answer 8

Kawasaki

Question 9

Diarrhoea

Bloody / mucus

Fever

Unwell

Answer 9

Gastroenteritis - bacterial

shigella, campylobacter, salmonella

Question 10

Differentials for this rash

Answer 10

1. HSP In Henoch-Schonlein Purpura you typically see a palpable purpuric rash symmetrically on the legs and buttocks.
2. Menigococcal infection
3. ITP In ITP the very low platelet count can give rise to a petechial/purpuric non-blanching rashes and mucosal bleeding.​

Question 11

What are the 2 signs of meningitis (assoc with neck stiffness)?

Answer 11

Both supine:

1. Kernig sign - back pain on extension of knee from 90*
2. Brudinski sign - flexion of neck will cause flexion of knees and hips

Question 12

Severe abdominal Pain, one-sided

Haematuria

Dipstix only shows blood +++ and Leukocytes trace

Answer 12

Renal calculi

(USS renal tract)

Question 13

flu-like symptoms:

• including a high temperature of 38C or above, a sore throat and swollen neck glands
• Strawberry tongue
• Sandpaper rash

Answer 13

Scarlet fever

strep pyogenes

Question 14

• Fever
• Red, sore eyes, sensitive to light
• coryza
• cough
• sore throat
• koplik spots
• red/brown rash starting from forehead and moving down

Answer 14

Measles

measles virus

Question 15

• sore, blistering, itchy rash
• fever
• tiredness, malaise, aches, pains
• headache
• decreased appetite

Answer 15

Chickenpox / Varicella

VZV

Question 16

• a high temperature of 38C or more
• a runny nose and sore throat
• a headache
• few days later: bright red rash on cheeks, lacey rash on body

Answer 16

Slapped cheek

human parvovirus B19

Question 17

• Following a viral illness
• development of bruising / purpuric rash
• low platelets

Answer 17

ITP

I: low platelets on clotting screen

complications: serious bleeding
m: steroids, immunoglobulins

Question 18

• history of URTI
• vasculitis
• rash

Answer 18

HSP

I: urinalysis

complications: kidney failure (segmental GN)

T: symptomatic, steroids, pain relief

Question 19

• Poor feeding
• Failure to thrive
• Recurrent LRTI
• Congestive heart failure
• SOB

Answer 19

Congenital heart defect e.g.

• Acyanotic
  
  • VSD
  • ASD
  • PDA
• Outflow obstruction
  
  • coarctation of the aorta
• Cyanotic
  
  • Tetrallergy of Fallot
  • Transposition of the great arteries
  • truncus arteriosus
  • Tricuspic valve abnormalities
  • Total anomalous pulmonary venous connection