Presentations & Differential Diagnosis Flashcards
A child is brought to A+E with acute onset abdominal pain. What is the most common surgical cause of acute abdo in children?
Appendicitis
A child is brought to A+E with acute onset abdominal pain. What is the most common non-surgical cause of acute abdo in children?
Gastroenteritis
A neonate is brought to A+E with persistent crying and difficulty feeding. What might be wrong?
The child might have acute abdominal pain
How does acute abdominal pain present in a child who can talk?
They tell you, duh
What symptoms are important to ask about when taking an acute abdomen history in a child?
Vomiting, diarrhoea, fever, groin pain, urinary symptoms, bowel symptoms inc. bloody diarrhoea, vaginal discharge.
What sign might a baby have to indicate pain?
Abnormal facial expression
What are we testing when we ask a child to suck their abdomen in and blow it out?
To check for the level of the pain and exclude peritonitis if they do it without pain.
What are the medical causes of acute abdominal pain for infants?
Gastroenteritis, UTI, constipation.
What are the medical causes of acute abdominal pain for children aged 2-5?
Gastroenteritis, UTI, and constipation.
What are the medical causes of acute abdominal pain for children aged 6-11?
Gastroenteritis, UTI, and constipation.
What are the medical causes of acute abdominal pain for children aged 12-18?
Gastroenteritis, UTI, and constipation.
What are the surgical causes of acute abdominal pain for infants?
Intussusception, volvulus, incarcerated hernia, Hirschsprung’s
What tool can be used to assess the need for further investigation of abdominal pain?
Paediatric appendicitis score (PAS)
What are the other non-surgical causes of acute abdominal pain for children aged 12-18?
Dysmenorrhoea, DKA, mittelschmerz, threatened abortion, ectopic pregnancy, IBD, adrenal crisis, PID
What are the surgical causes of acute abdominal pain for children aged 2-5?
Appendicitis, intussusception, volvulus, trauma
What are the surgical causes of acute abdominal pain for children aged 6-11?
Appendicitis, trauma
What are the surgical causes of acute abdominal pain for children aged 12-18?
Appendicitis, trauma, ovarian torsion, testicular torsion
What are the other non-surgical causes of acute abdominal pain for infants?
Infantile colic
What are the other non-surgical causes of acute abdominal pain for children aged 2-5?
Mesenteric lymphadenitis, HSP, DKA, Sickle cell crisis
What are the other non-surgical causes of acute abdominal pain for children aged 6-11?
Mesenteric lymphadenitis, HSP, DKA, Sickle cell crisis, pneumonia, functional pain, abdominal migraine.
What is the PAS?
Score designed to show if abdominal pain needs further assessment in children.
What scores points on the PAS?
Migration of pain (1), anorexia (1), N+/or vomiting (1), RLQ pain (2), cough/percussion/hopping tenderness (2), fever (1), leukocytosis or neutrophilia (1 each)
What 2 socially concerning things would make the differential list for an acute abdomen?
Drug use and child abuse.
A child is brought to A+E with a high pitched whistling sound when they breath out. What 4 ways can this occur?
Bronchospasm, mucosal lining swelling, excessive secretions, or inhaled foreign body.
A child is brought to A+E with a high pitched whistling sound when they breath out. They were previously playing with some lego, and then all of a sudden this noise started. What is your top differential?
Inhaled foreign body, probably a bit of lego
When in wheezing least common in childhood?
In the immediate neonatal period
A child is brought to A+E with a high pitched whistling sound when they breath out. This occurred after a P.E lesson in which they did the beep test. What is your top differential?
Exercise induced wheeze ?asthma
What is a frequent cause of wheeze in pre-school children?
Viral/bacterial URTIs e.g. croup, bronchiolitis, cold/flu
What GI problem could cause a wheeze in a child?
Gastro-oesophageal reflux
A child with a wheeze comes to A+E. What red flags would indicate the need for immediate assessment and care?
Poor feeding, cyanosis, respiratory distress, drowsiness, poor response to treatment
What does a wheeze starting perinatally suggest?
A structural abnormality
What kind of structural abnormality might cause a perinatal wheeze?
Tracheo-oesophageal fistula, heart failure/congenital heart disease, extrinsic airway compression, tracheobronchomalacia
How is a transient wheeze in infancy managed?
Short term inhaled bronchodilators, treat the cause if possible.
What investigations might be necessary for a child presenting with a wheeze?
CXR if foreign body, structural abnormality, or pulmonary mass/infiltrate suspected, swaet test for CF, allergy test, Barium swallow, spirometry if over 6 years old.
What are the main priorities when first assessing a pt with vomiting or diarrhoea?
Presence and degree of dehydration, and underlying cause especially if life-threatening
What are some of the more sinister causes of vomiting?
DKA, meningitis, subarachnoid, RICP, bowel obstruction, malignancy, peritonitis, torsion (test/ovarian)
What are the consequences of untreated vomiting?
Dehydration, metabolic alkalaemia, hyponatraemia, hypokalaemia, haematemesis
What are the consequences of untreated diarrhoea?
Dehydration, hypokalaemia
A child comes to the GP with it’s mother because they have been having back pain. How common is nonspecific back pain in children?
Depends on population, but can be up to 2/3s of children at some point.
When is back pain most common in children?
Times of rapid growth, so more common with increasing age
Which sports is back pain most associated with?
Gymnastics, dancing, american football, diving, wrestling, rowing, rugby
