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OSCE Paeds > Recognise, investigate & manage > Flashcards

Recognise, investigate & manage Flashcards

1
Q

investigate space-occupying lesion headache

A

FBC, U&Es, LFTs,
MRI head (better than CT)

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2
Q

manage space-occupying lesion headache

A

NSAIDs/paracetamol
anti-emetics eg prochlorperazine & metoclopramide if N&V
tx tumour

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3
Q

breath holding attacks differentials

A

epilepsy

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4
Q

breath holding attacks investigations

A

ECG
EEG

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5
Q

breath holding attacks mx

A

reassurance
advice for further episodes (make environment safe, recovery position)
safety-net when to bring back

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6
Q

migraine dx & mx

A

clinical

analgesia & sumatriptan (seretonin agnoist)

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7
Q

hydrocephalus ix

A

cranial USS infants // CT/MRI if older

monitor head circumference on centile chart

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8
Q

hydrocephalus mx

A

ventriculoperitoneal shunt for drainage of symptomatic

symptomatic relief of raised ICP & minimise neurological damage

antiemetics

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9
Q

HUS ix

A

FBC & blood film
U&Es
stool sample, microscopy & culture

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10
Q

HUS mx

A

supportive: fluids, blood transfusions & dialysis
plasma exchange if severe cases (non-diarrhoea associated)
NO Abx needed

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11
Q

nephrotic syndrome ix

A

Urinalysis (dip stick: protein +++), microscopy, culture, and urinary protein/creatinine ratio

Urine microscopy (just in case)

FBC, U&Es, Creatinine, LFTs, C3/C4

Blood pressure

Urinary sodium concentration (helpful for those at risk of hypovolaemia)

Varicella titres (varicella status should be known in all children commencing steroids)

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12
Q

nephrotic syndrome mx

A

4 week course of Prednisolone (Oral steroids)

IV Albumin (indicated if clinical hypovolaemia or symptomatic oedema)

Prophylactic Penicillin V

Salt/fluid restriction

Pneumococcal vaccination

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13
Q

anaphylaxis differentials

A

shock // vasovagal // asthma/COPD

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14
Q

anaphylaxis ix

A

A-E
tryptase later to confirm
vitals
cultures

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15
Q

anaphylaxis mx

A

Position supine and raise legs

Establish airway if compromised and give high flow oxygen.

**Adrenaline (epinephrine)
**
IV saline

Salbutamol

Antihistamine

Steroid

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16
Q

measles differentials

A

rubella, scarlet fever, kawasaki, slapped cheek

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17
Q

measles ix

A

clinical
ENT & chest exam
salivary swab, serum sample - measles IgM & RNA

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18
Q

measles mx

A

Notify the health protection unit

Self-limiting

Advise rest and plenty of fluid intake and calpol for any fevers

Exclusion from school for 4 days from rash onset

Vaccinate other children

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19
Q

periorbital cellulitis ix

A

cultures

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20
Q

periorbital cellulitis mx

A

urgent ophthal review
Abx (co-amoxiclav // ceftriaxone)
hot compresses
nasal decongestants & vasoconstrictors help drain sinuses
surgical drainage (supportive preseptal cellulitis)

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21
Q

chickenpox ix

A

clinical (rash)
VZV IgM serology, e-microscopy of vesicle fluid

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22
Q

chicken pox mx

A

Antipyretic (for pyrexia) and oral antihistamine (for itching).

School exclusion for 5 days (from start of skin eruption).

Acyclovir if severe Varicella (or pregnant, babies, immunocompromised).

23
Q

conjunctivitis ix

A

clinical
conjunctival swabs
stain eyes
test acuity
check foreign body

24
Q

conjunctivitis mx

A

abx eye drops - chloramephenicol
fusidic acid (good for staph infections)
if allergic conjunctivitis - topical oral antihistamine & avoid allergen

25
Q

cow milk allergy ix

A

Skin-prick testing for IgE mediated allergy

Measurement of specific IgE antibodies in blood (RAST test)- specifically for cow’s milk

If still in DOUBT, the gold standard test is exclusion of the relevant food under dietician’s supervision, followed by a double-blind placebo controlled food challenge, in HOSPITAL

26
Q

cow milk allergy mx

A

Extensive hydrolysed formula (eHF) milk is the first-line replacement formula for infants on formula with mild-moderate symptoms

Exclusion of cow’s milk until 6 months of eHF/Until patient is 12 months old. As cow’s milk allergy usually stops 1-2 years of age. (Challenge could be performed in hospital then)

27
Q

IM ix

A

Blood film (peripheral leucocytosis)
positive agglutination test (monospot test)
EBV IgM antigen
abnormal LFTs

28
Q

IM mx

A

Avoiding spread – no kissing, sharing utensils etc, avoid collision sports

Supportive Management – hydration and analgesia

Steroids if severe

29
Q

haemophilia differentials

A

child abuse // mongolian blue spots

30
Q

haemophilia ix

A

bloods (FBC, APTT & FVIII/FIX)

31
Q

haemophilia mx

A

IV infusion of FVIII or vasopressin
tranexamic acid for mucosal bleeding
joint pain - dressing, rest, ice, compress & elavate

can have normal life as long as given appropriate treatment

32
Q

HSP ix

A

U&Es // FBC
urine dipstick

33
Q

HSP mx

A

rest
drink fluids
ibuprofen // paracetamol

resolves on its own

34
Q

leukaemia/sickle cell anaemia ix

A

FBC (check WBC - neutropenia RBC-anaemia
Bone marrow biopsy

35
Q

leukaemia/sickle cell anaemia mx

A

Reassurance, Immediate referral

36
Q

otitis media ix

A

otoscopy // swab & culture

37
Q

otitis media mx

A

Reassurance abx aren’t needed at present, should be started at 4 days post onset

5 day course of abx – amoxicillin; if allergic – erythromycin or clarithromycin

Second line abx: co-amoxiclav

Seek specialist advice – ENT specialist and microbiologist

38
Q

epiglottitis ix

A

Fibre optic laryngoscopy (Gold standard)

Throat swab

Bloods and blood cultures

39
Q

epiglottitis mx

A

ABCDE approach. DO NOT EXAMINE THROAT

Admit patient

Call anaesthetist to intubate patient (most likely scenario)

IV or Oral Abx

40
Q

CF ix

A

sweat test
Guthrie test

41
Q

CF mx

A

MDT approach with annual review

Physiotherapy twice a day (Airway clearance at home in younger children)

Continuous prophylactic oral antibiotics (usually flucloxacillin)

Nebulised antipsudomonal antibiotics (if lung deterioration)

Nebulised DNAse or hypertonic saline may be helpful to decrease the viscosity of sputum and so increase its clearance

Bilateral lung transplantation for end stage CF lung disease

Pancreatic insufficiency is treated with oral enteric coated pancreatic replacement therapy with all meals and snacks

High calorie and high fat diet

Multivitamin supplementation

42
Q

mesenteric adenitis ix

A

GI exam (no rebound tenderness but shifting tenderness present)

Clinical diagnosis

Bloods (FBC, ESR/CRP)

43
Q

mesenteric adenitis mx

A

Watch and wait to see if symptoms remain the same or worsen

Advise to use calpol for fever and for pain

If the pain goes to Right Iliac Fossa then come back for surgical exploration

44
Q

pyloric stenosis ix

A

GI exam
gas (hypochloraemic, hypokalaemic metabolic acidosis)
test feed
USS doughnut shape
barium swallow - string sign

45
Q

pyloric stenosis

A

IV fluids (0.45% saline + 5% Dextrose + 80 mmol/L KCl)

Ramstedt’s pyloromyotomy + nil by mouth

46
Q

gastroenteritis ix

A

stool sample analysis
assess for shock
bloods – U&E’s, urea, creatinine and glucose & Sigmoidoscopy

47
Q

gastroenteritis mx

A

Continue usual feeds

ORS, give frequently and in small amounts; for children >5yrs – give 200ml ORS after each loose stool

Abx 5 day course: most organisms respond to Ampicillin, cotrimoxazole or 3rd gen cephalosporin (If campylobacter- erythromycin; PO vancomycin/metronidazole if C diff)

48
Q

appendicitis ix

A

Clinical examination (guarding, rebound tenderness)
Bloods (FBC, U&E’s, LFT’s , CRP and BM)
BUFALO
CXR/AXR

49
Q

appendicitis mx

A

ABCDE management

High flow O2 non-rebreathe mask, 15L/min; auscultate chest - clear

2 wide bore IV cannula’s, bolus 200ml crystalloid solution + dextrose

Heart monitoring equipment, ECG + CXR

Bloods – FBC, U&E’s, LFT’s , CRP and BM

BUFALO

Surgery – remove inflamed appendix

50
Q

coeliac ix

A

jejunal biopsy
TTG
FBC
gluten challenge

51
Q

coeliac mx

A

Supervision of diet by dietician, if dx uncertain

Prevention - continued breast feeding and weaning

Nutritional advice – lifelong gluten free diet; vitamin, calcium and iron supplements

Follow-up – membership of www.coeliac.org.uk

52
Q

hypothyroidism ix

A

TFTs, Growth charts, monitor developmental milestones closely

53
Q

hypothyroidism mx

A

L-thyroxine, regular TFT monitoring to prevent development of irreversible neurological disability

OSCE Paeds (24 decks)

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