Presenting Complaint

Question 1

Fever

Answer 1

*Common*: 
Rhinitis (common cold)
Otitis media
Pharyngitis
Skin infections
Urinary tract infection
Septicaemia
Viral infections (with or without rash)

*Less Common*:
Osteomyelitis/septic arthritis
Meningiitis / encephalitis
Malaria/typhoid/dengue and
other imported fever
Inflammatory bowel disease
TB
HIV
Kawasaki disease
Rheumatological / connective
tissue disease (sJIA) / vasculitis

Question 2

Breathing Difficulty

Answer 2

*Common*: 
Bronchiolitis
Asthma
Croup
Pneumonia 

Uncommon:
Cystic fibrosis
Heart failure
Laryngomalacia (infants)

Question 3

Persistent Cough

Answer 3

*Common*: 
Bronchiolitis
Pneumonia
Asthma
GOR – in infancy
Post-nasal drip / sinusitis

*uncommon*:
Inhaled foreign body
TB
Cystic fibrosis
Bronchiectasis

Question 4

Diarrhoea and/or vomiting

Answer 4

Common:
Gastroenteritis
Appendicitis

Uncommon:
Pyloric stenosis
Malrotation/volvulus
Diabetic ketoacidosis

Question 5

Abdominal Pain

Answer 5

*Common*: 
Mesenteric adenitis
Chronic constipation
Appendicitis
UTI
Somatisation (incl. Recurrent abdo
pain)

*Uncommon*: 
Lower lobe pneumonia
Obstruction (incl. intussesception)
Pancreatitis
Diabetic ketoacidosis
Henoch Schonlein purpura

Question 6

Rectal Bleeding

Answer 6

Common:
Fissure in ano

Uncommon:
Inflammatory bowel disease
Meckel’s diverticulum

Question 7

Headache

Answer 7

*Common*: 
Tension
Migraine
Myopia / hypermetropia
Post-ictal

*Uncommon*: 
Meningitis/encephalitis
Sinusitis
Idiopathic Intracranial
hypertension (used to be called
benign intracranial hypertension)
Raised intracranial pressure/space
occupying lesion

Question 8

Fits / Faints

Answer 8

*Common*
Febrile convulsion
Vasovagal syncope
Breath holding attacks
Idiopathic epilepsy

*Uncommon*: 
Meningitis/encephalitis
CNS injury – hypoxia
Metabolic – hypoglycaemia,
hypocalcaemia (Rickets)

Question 9

Limp / joint pain

Answer 9

Common:
Reactive
Trauma

*Uncommon*: 
Osteomyelitis
Septic arthritis
Slipped upper femoral epiphysis
Developmental dysplasia of hip
Osteochondritides (Perthe’s /
Osgood-Schlatter)
Leukaemia
Rheumatoid arthritis

Question 10

Deliberate Self-Harm e.g. cutting,

overdose and substance abuse

Answer 10

Common:
Depression
Psychosocial problems

Uncommon:
High level suicidal intent
Emotional Abuse
Mental illness

Question 11

Rashes / skin lesions

Answer 11

*Common*: 
Viral exanthema
Molluscum
Eczema
Acne
Rashes of newborn

*Uncommon*: 
Skin infections (Staph / Strep)
Erythema multiforme/nodosum
HSP
Insect bites / scabies
Fungal infection (ringworm, tinea)
Non-accidental injury

Question 12

Itchy rash / itchy nose (atopy)

Answer 12

Common:
Food allergy
Eczema
Allergic rhinitis

Uncommon:
Drug reaction (incl StevensJohnson
syndrome)
Urticaria

Question 13

ENT & eye problems (may be

acute or seen in OPD/community)

Answer 13

Common:
Otitis media and externa

*Uncommon*: 
Foreign body injury
Sinusitis
Periorbital cellulitis
Orbital cellulitis

Question 14

Lumps and bumps – other masses

including oncology

Answer 14

Common:
Lymphadenopathy
Bruising
Hernias

Uncommon:
Solid tumours
Pregnancy

Question 15

Urinary problems – dysuria,

haematuria

Answer 15

Common:
UTI
Enuresis
Nephrotic syndrome

Uncommon:
Nephritic syndrome
Renal stones

Question 16

Obesity

Answer 16

Common:
Obesity

Uncommon:
Cushing’s
Steroid chronicity
Polycystic ovarian syndrome

Question 17

Faltering growth

Answer 17

*Common*: 
Caloric insufficiency
Neglect, child abuse
Chronic illness – Cyanotic CHD,
eliac, cystic fibrosis
Diabetes mellitus
Syndromes – Down/Turner
Constitutional delay

*Uncommon*: 
Other chromosomal syndromes
e.g. trisomy13, 18.
Immunodeficiency
Hypothyroidism, Inborn errors of
metabolism (IEM)

Question 18

Abnormal puberty

Answer 18

Common:
Constitutional delay
Premature thelarche /
adrenarche / menarche

*Uncommon*: 
Turner
Cushing
Anorexia nervosa
CNS tumours
Sex steroid secreting tumours
Primary hypothyroidism
21-hydroxylase deficient
congenital adrenal hyperplasia

Question 19

Short stature

Answer 19

*Common*: 
Constitutional delay
Familial
Chronic disease – CF, CHD, eliac,
sickle cell disease, thalassaemia,
IBD
Hypothyroidism
Down
Malnutrition

*Uncommon*: 
Renal tubular acidosis
Glucocorticoid excess
GH deficiency
CNS disease-tumours
Turner/Noonan/Prader-Willi

Question 20

Pallor

Answer 20

Common:
Iron deficiency anaemia
β thalassaemia
Sickle cell disease

Uncommon:
G6PD deficiency
Leukaemia

Question 21

Bruising

Answer 21

Common:
ITP

*Uncommon*: 
Haemophilia A &B
Von Willebrand disease
Non-accidental injury (often
unusual pattern)
Leukaemia

Question 22

Atypical or unusual infection

Answer 22

Common:
HIV

Uncommon:
Congenital immunodeficiency

Question 23

Bone pain

Answer 23

Common:
Leukaemia

Uncommon:
Primary bone tumours e.g.
Ewing’s sarcoma

Question 24

Developmental delay – isolated /

global (under fives)

Answer 24

*Common*: 
Environmental understimulation
Iron deficiency
Cerebral palsy (including hypoxic
ischaemic encephalopathy

Uncommon:
Inborn error of metabolism
Brain dysplasia

Question 25

Learning difficulties – slow school | progress

Answer 25

*Common*: Hearing impairment Visual impairment Low intelligence *Uncommon*: Specific learning impairments (dyslexia, dysgraphia , auditory processing disorders)

Question 26

Poor social skills, repetitive | behaviours, delayed language

Answer 26

Autistic spectrum disorder

Question 27

``` Feeding problems Sleep disorders Excessive crying Aggressive behaviour/Parenting issues ```

Answer 27

*Common*: Gastroesophageal reflux Colic Temper tantrums *Uncommon*: Texture aversion Food allergy

Question 28

Chronic pain/unexplained | symptoms

Answer 28

Somatisation

Question 29

Dysmorphic – an approach to the | dysmorphic child

Answer 29

*Common*: Down Turner Noonan ``` *Uncommon*: Inborn errors of metabolism Congenital infection Teratogenesis –e.g, maternal alcohol use ```