Primary Care

Question 1

What should you be concerned about in a very overweight child with short stature?

Answer 1

Endocrine cause

Question 2

What is the most common causative organism of UTI in children?

Answer 2

E.coli

Question 3

Give some concerning features of UTI

Answer 3

• Frequent infections
• Non-E.Coli pathogens
• Family history of renal disease
• Poor growth/general health
• Poor urinary flow in infant – think obstruction, possible urethral valve in boys
• Voiding problems/constipation
• Spinal abnormality
• Raised blood pressure
• Renal tract abnormalities on antenatal scan
• Abdominal mass

Question 4

What is encopresis?

Answer 4

Passage of normal stool in abnormal places

Question 5

At what age should you be worried about a newborn not passing meconium?

Answer 5

> 24 hours after birth

Question 6

What are some concerning features of headache?

Answer 6

Headache on waking
Worse with coughing or bending
Associated vomiting- especially in the morning
visual disturbance
Gait disturbance
Cranial nerve palsy

Question 7

What are some red flags for cardiac syncope in children?

Answer 7

• Syncope in a child with known congenital heart disease
• Syncope during exercise or when supine
• Family history of sudden death, prolonged QT syndrome or hypertrophic cardiomyopathy – do an ECG to look at the QT interval
• Syncope preceded by palpitations
• Heart murmur or other abnormalities on cardiovascular examination

Question 8

What are some features of an innocent heart murmur in children?

Answer 8

Systolic
Low intensity
2nd left interspace
Medial to apex
Beneath either clavicle (may be continuous- ‘venous hum’ –disappears when supine

Question 9

What are some red flag features of heart murmur in children?

Answer 9

Any Diastolic 
Loud > grade 3
Harsh
Associated thrill
Radiate widely
Other symptoms/signs – breathless, poor feeding, pallor, sweating, syncope, poor growth, dysmorphism, FH

Question 10

Where is the shunting in VSD?

Answer 10

VSD – left to right shunt, can also occur an ASD – more blood through lungs, causing pulmonary hypertension, which will ultimately lead to right to left shunt, so you turn blue.

Question 11

What are some clinical features that increase the probability of asthma?

Answer 11

• Personal history of atopic disease
• Family history of atopic disease and/or asthma
• Widespread wheeze heard on auscultation
• More than one of the following symptoms: wheeze, cough, difficulty breathing, chest tightness
  Particularly if these are frequent and recurrent; are worse at night/early morning; occur in response to/are worse after exercise or other triggers such as exposure to pets, pollens, cold or damp air, or with emotion, laughter; or occur apart from colds.