Presentations Flashcards
1
What are differentials for Learning difficulties - slow school progress?
Common causes:
Hearing impairment
Visual impairment
Low intelligence
Less common causes:
Specific learning impairments (ADHD, dyslexia, dysgraphia, auditory processing disorders)
what is dysgraphia
neurological disorder that impairs writing ability and fine motor skills.
affects spelling, word spacing, sizing, expression
kids + adults
what is an auditory processing disorder?
If you or your child have APD, you may find it difficult to understand:
people speaking in noisy places
people with strong accents or fast talkers
similar sounding words
spoken instructions
Hearing is normal, just difficulty understanding sounds
2
What are differentials for Poor social skills, repetitive behaviours, delayed language
Common causes
Autism spectrum disorder
Less common causes
Parenting issues
To add:
Neglect - can delay language
Delayed language has long list of differentials including receptive and expressive causes.
A child seems to have reached the limit for some of their milestones but is behind for others. how do you describe this?
Normal development implies steady progress in all four developmental fields with acquisition of skills occurring before limit ages are reached.
If there is developmental delay, does it affect
all four developmental fields (global delay), or one or
more developmental field only (specific developmental
delay)
In development, some kids dont follow regular pattern. Is this pathological?
There is variation in the pattern of development
between children.
Taking motor development as an
example, normal motor development is the progression
from immobility to walking, but not all children
do so in the same way. While most achieve mobility
by crawling (83%), some bottom-shuffle and others
become mobile with their abdomen on the floor,
so-called commando crawling or creeping (Fig. 3.3). A
very few just stand up and walk.
The LOCOMOTOR PATTERN (crawling, creeping, shuffling and just standing up)
determines the age of sitting, standing and walking.
The limit age of 18 months for walking applies predominantly to children who have had crawling as their
early mobility pattern.
Children who bottom-shuffle or
commando crawl tend to walk later than crawlers, so
that within those not walking at 18 months of age there
will be some children who demonstrate a locomotor
variant pattern, with their developmental progress still
being normal. For example, of children who become
mobile by bottom-shuffling, 50% will walk independently
by 18 months and 97.5% by 27 months of
age, with even later ages for those who initially commando crawl. Some children who walk late have joint hypermobility.
There is however a limit of development - a time limit by which each thing SHOULD have been achieved or it is a red flag. eg head control by 4 months and walking is by 18months. page 35 Lissaeur
how do you know if a baby’s hearing is fine?
Around birth - Startles and blinks at a sudden noise, e.g. slamming of door
1 month - notices and PAUSES to listen to prolonged sounds
7 months -Turns immediately to your voice across the room
which differentials can cause: Feeding problems, Sleep disorders, Excessive crying, Aggressive behaviour / hyperactivity?
Common causes: Gastroesophageal reflux Colic Temper tantrums Eating disorders (anorexia, bulimia) Anxiety, breath holding attacks
Less common causes: Food allergy ADHD Nightmares / night terrors Parenting issues Sleep apnoea Texture aversion
which differentials can cause: Chronic pain/unexplained symptoms
Common causes:
Somatisation
Less common causes:
Fabricated or induced illness
What are some causes of postnatal collapse?
Common causes:
Sepsis
Congenital heart disease
Less common causes:
Metabolic & Endocrine diseases eg:
Congenital adrenal hyperplasia
Others:
GI - Hirschsprung, NEC, Malrotation
Neuro - seizures, hydrocephalus
Non-accidental injury
What are some causes of a jittery baby?
Common causes:
Hypoglycaemia
Less Common:
Drug withdrawal (Neonatal Abstinence Syndrome)
Hypocalcaemia
Sepsis
Polycythaemia (can result from respiratory distress/insuffiency)
out of the causes of Seizures / Abnormal Neurology, which are most common?
Common causes:
Hypoglycaemia
Hypoxic ischaemic encephalopathy
Less Common: CNS infection (eg. Meningitis, HSV encephalitis) Hypocalcaemia Drug withdrawal Shoulder dystocia (Erb palsy)
what are the differentials for diarrhoea and/or vomiting in paeds?
medlearn
Common causes: Gastroenteritis (including rotavirus) Constipation with overflow Toddler diarrhoea Food poisoning - vomiting + d
Less common causes: Inflammatory bowel disease Malabsorption - Lactose intolerance, coeliac etc Food allergy Pyloric stenosis - vomiting Malrotation/volvulus - vomiting Diabetic ketoacidosis - vomiting Appendicitis - vomiting Psychosocial / behavioural ----- Antibiotics - in older kids Laxative abuse
Define acute and chronic diarrhoea
acute: <2weeks
chronic: >2 weeks
what additional questions do you ask in a diarrheoa hx?
Fever: infectious diarrheoa
Blood/mucus in stool: bacterial pathogen
Farm animal exposure: salmonella, e.coli
Suspicious & undercooked foods: cookie dough +e.coli
Recent travel
Antibiotic use: c.diff or abx alone
what should physical exam and ivx to include in diarrheoa?
Exam: Assess hydration status Systemic infection/signs of illness Abdominal exam Perianal exam
Investigations:
Bloods: U&Es for hydration status
Condition specific:
IBD - high ESR/CRP, Faecal calprotectin, endoscopy?
CF - sweat test, stool elastase
Malabsorption - appropriate tests, faecal fat,
Coeliac - low IgA, anti-TTG +ve -> gut biopsy
we do NOT routinely do stool cultures.
What additional questions shoud one ask in vomiting hx?
Colour of vomit
- Green/bilous: obstruction / malrotation, duodenal atresia
- non-bilious: GOR
- blood: MW tear, gastritis
Duration:
- few days: viral
- acute: dka
- delay: pancreas/ pancreatitis
Timing in relation to feeds:
- immediate: oesophageal problem
- slight delay: stomach
Associated sx:
- Heaches -signs of increased ICP (can be due to trauma)
- UTI sx
Assess hydration:
- Drinking/ urinating?
PMHx:
Appendix removed?
SH:
Non accidental injury / trauma
what physical exams and investigations do we conduct for vomiting presentation?
Basic obs: Temp, HR, RR, Sats
Hydration status: cap refill, mucus mebrane
Abdo exam: distension / peritonitis (acute abdomen), rebound tenderness (appendcitis), suprapubic or flank tenderness (uti, pyelonephritis)
Neuro exam: pupillary reflex (ICP)
General exam: peripheral stigmata
Investigations:
1. Pregnancy test - teenage girls
- Bloods:
Urea:Creatinine ratio - high if dehydration
High creatinine alone - renal causes
Blood gas - acidosis (diarrhoea n dehydration), alkalosis (excess vomiting) - Urinalysis - (UTI),
LP (only if thinking meningitis)
Imaging:
- AXR:
- mutliple air-fluid levels: gastroenteritis (should be solid not fluid) - Ultrasound:
- pyloric stenosis, intussusception
Obviously, each condition has its own test you would do
what are the differentials for abdomninal pain?
Common causes: Mesenteric adenitis Chronic constipation Appendicitis UTI / pyelonephritis Somatisation (incl. recurrent abdo pain)
Less common causes: Lower lobe pneumonia - referred pain!! Obstruction (incl. intussusception, hernia) Intra-abdominal mass (faecal, organomegaly, tumour) Diabetic ketoacidosis Henoch Schonlein purpura Hepatitis A prodrome Sickle cell disease
What are the differentials of constipation?
Poor diet
Allergies / Lactose intolerance
Irritable bowel syndrome (1/2) Hirschsprung Endocrine: hypothyroid Neurological Encopresis: if overflow
what are the differentials for rectal bleeding?
Common causes:
Fissure in ano
Enteric infection (Campylobacter, E coli, Shigella)
Intussusception
Less common causes:
Inflammatory bowel disease
Food allergy
Meckel’s diverticulum
rectal polyp
what are the differentials for the Presenting Feature: Limp/Joint pain
Common causes
Reactive arthritis
Trauma (incl. non-accidental injury)
Benign: sprain/strain,
-------- Less common causes: Osteomyelitis - serious Septic arthritis - serious Slipped upper femoral epiphysis Developmental dysplasia of hip
Osteochondritides (Perthes / Osgood-Schlatter)
Systemic onset Juvenile Ideopathic Arthritis (SOJIA)
Vitamin D deficiency (rickets)
Sickle cell disease / haemophilia
Malignancy (leukaemia, osteosarcoma):
- must screen for fever, weight loss, check for lymphadenopathy etc
what is the difference between child and adult limp?
in kids, we have a HIGH index of suspicion for cancers eg leukaemia, bone infections eg osteomyelitis or congenital bone disease. So we do a rigorous investigation upfront
What questions should we ask in a presentation of Limp?
- Duration
- Trauma and source
- note some are associative rather than causative
Fever
- 3 days icnreasing fever: osteomyelitis
- 1-2 weeks waxing n waning fever: leukaemia
Associated sx:
localised pain - osteomyelitis
bruising, rahses, gum bleeding - Leukaemia
Coryzal sx before limp - synovitis (ask about siick contacts)
Jaundice, chest pain - sickle cell
FH- haemophilia, etc
Diet hx - rickets
