Spot Diagnosis Flashcards
I am a condition that arises from damage to the immature brain.
Cerebral Palsy
I am a condition arising from damage to the immature brain. You are the doctor what is the condition given that there are 4 main forms of this condition
spastic (70%): hemiplegia, diplegia or quadriplegia
dyskinetic
ataxic
mixed
which condition am I?
Cerebral Palsy
I am a condition arising from damage to the immature brain. You have finished the history and examination and go on to make a diagnosis.
The medical management for my condition includes spasticity medication such as oral diazepam, oral and intrathecal baclofen, botulinum toxin type A, orthopaedic surgery selective dorsal rhizotomy
Which condition am I?
Cerebral Palsy
- M>F
- 5-10% Family history of parents
- Projectile vomiting at 4-6 weeks of life
- Diagnosis is made by test feed or USS
- Treatment: Ramstedt pyloromyotomy (open or laparoscopic)
- Hypochloremic Hypokalaemic metabolic alkalosis
which condition am I?
Pyloric stenosis
- Proximal to or at the level of, ileocaecal valve
- 6-9 months age
- Colicky pain, diarrhoea and vomiting, sausage shaped mass, red jelly stool.
- Treatment: reduction with air insufflation
Which Condition am I?
Intussusception
Jaundice > 14 days
Increased conjugated bilirubin
Urgent Kasai procedure
Which condition am I?
Biliary atresia
emergency department
4-year-old child
sore throat which has rapidly become worse over the last 3 hours,
a high fever and has begun drooling from the sides of his mouth. His mother admits he has missed some of his vaccinations
soft high pitched sound is just audible on inspiration
Which condition am I?
acute epiglottitis
Haemophilus influenza type B
18-month-old
Three days ago he started with fever, cough and rhinorrhoea
wheezy
On examination his temperature is 37.9ºC, heart rate 126/min, respiratory rate 42/min and a bilateral expiratory wheeze
inhaler has made little difference to the wheeze
viral-induced wheeze
a degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years
5 times more common in boys
hip pain: develops progressively over a few weeks
x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening
Perthes’ disease
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
Patau syndrome (trisomy 13)
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
Edward’s syndrome (trisomy 18)
Hypotonia
Hypogonadism
Obesity
syndrome has no cure
Prader-Willi syndrome
NICE issued guidance in 2010. Management:
look for possible underlying causes/triggers (e.g. Constipation, diabetes mellitus, UTI if recent onset)
advise on fluid intake, diet and toileting behaviour
reward systems (e.g. Star charts). NICE recommend these ‘should be given for agreed behaviour rather than dry nights’ e.g. Using the toilet to pass urine before sleep
Nocturnal Enuresis
The commonest murmur heard in children
- Soft
- Systolic
- Asymptomatic
- Left sternal edge
and no added heart sounds
Innocent murmur
Example:Increased flow across branch pulmonary artery, Stills murmur, Venous hum
Long Systolic Murmur
VSD
Overriding Aorta
Right Ventricular Hypertrophy
Pulmonary Stenosis (right ventricle blood vessel narrowing)
Tetralogy of Fallot
Right Lateral thoracotomy scar
right modified Blalock Taussig Shunt (RMBTS)
Tetralogy of Fallot
Differentials for a left lateral thoracotomy scar
Tetralogy of Fallot (RMBTS / LMBTS)
Coarctation of the aorta repaired
Pulmonary artery band
Persistent arterial duct ligation
The child with Down’s Syndrome who has a murmur at the left lower sternal edge and a median sternotomy scar
AVSD / VSD
A child with median sternotomy scar and lateral thoracotomy scar with a systolic and diastolic murmur at the left sternal edge
Blalock Taussig Shunt, and then complete repair for Tetralogy of Fallot
15 month old girl Upper respiratory tract symptoms for 2 days crying ++ generalised convulsion lasting 2 minutes Temperature 39ºC Drowsy initially but soon started to respond Red left tympanic membrane Rest of examination normal
Febrile Convulsion and Otitis Media
FEBRILE CONVULSION 6 months to 6 years 3-5% of children Often familial Convulsion is generalised,<15 minutes
OTITIS MEDIA
red tympanic membrane
whining and crying, to screaming, kicking, hitting, falling down and breath holding
temper tantrum
is the commonest cause of death in the first year of life. It is most common at 3 months of age. Major risk factor is putting the baby to sleep prone
Sudden Infant Death Syndrome
Webbed neck, widely spaced nipples and wide carrying angle with aortic ejection systolic murmur
turners syndrome
turners syndrome examination findings on general inspection and auscultation of the heart
Webbed neck, widely spaced nipples and wide carrying angle with aortic ejection systolic murmur
Loose stools most likely diagnosis in the absence of other signs
lactose intolerance
Most common causative organism for this ear problem is haemophilus influenzae
otitis media
bilious vomiting
intussusception
haemophilia in teenage girls should lead you to suspect which genetic condition
turners syndrome
Right iliac fossa pain following a recent viral infection in children
Mesenteric adenitis
Viral exanthem of the Human herpes virus 6 Roseola infantum
fever followed by rash
Extra digits a cleft palate microcephaly and congenital abnormatlities form part of the presentation of which chromosomal abnormality
Patau 13
An 18 year old boy presents to the GP and it is obvious from when he works in that he has no physical evidence of puberty name a cause of delayed puberty associated with hypogonadotropic hypogonadism
Kallmann syndrome
You are the GP
A concerned mum tells you about her son who has not been feeling well recently has a swollen tummy and mum has also noticed blood in his nappies
Which conditions should you be worried about that is treated with empirical antibiotics
Necrotising enterocolitis
you are looking at the child’s eyes but you’ll notice that the left eye is looking inwards why has the right eyes looking straight at you what is this sign called
Esotropic strabismus
You are examining a child and noticed that the left eyes looking straight at you but the right eye is looking upwards what is this sign called
Hypertropic strabismus
You are looking at a child’s eyes and noticed that the right eye is looking straight at you but the last eyes looking down what is the name of this sign
Hypotropic strabismus
Whilst doing the Top To Toe baby check you notice that the baby doesn’t have a red reflex and in fact the pupil looks white whilst not pathognomonic this presentation is commonly seen in which type of Childhood cancer
Retinoblastoma
The doctor has just told me that my child has a condition called retinoblastoma does that mean she will die
No the prognosis is really good
Coxsackie A16 virus typically presenters which can the condition affecting the hands feet and mouth
Hand foot and mouth disease
Hi Dr I first noticed a rash on my child’s face that over the past couple of weeks has been spreading over his chest and back.
Whilst not a pathognomonic feature this type of presentation is typical for which virus
Rubella
Which virus causes slapped cheek syndrome
Parvovirus B19
Patent ductus arteriosus
collapsing pulse
