Week 2 - D - Common problems in paediatric outpatients

Question 1

What are some reasons for referral from primary care (GP) to secondary care (outpatient hospital) in paediatrics?

Answer 1

Concern re growth

• • UTI
• • Constipation
• • Abdominal pain
• • Headaches
• • Funny turns
• • Heart murmur
• • Food allergy/intolerances
• • Minor abnormalities in infants –eg head shape
• • Is it asthma?

Question 2

What are the two common causes of short stature?

Answer 2

Familial short stature

Constitutional delay of growth and puberty (CDGP)

Question 3

In an overweight child who has a very short stature, what needs to be considered for the cause?

Answer 3

An endocrine disorder

Question 4

Which bacteria is the most common cause of uncomplicated urinary tract infections in children?

Answer 4

Eschericha coli

Question 5

What is anothe rbacteria that can cause UTIs?

Answer 5

Staphylococcus saprophyticus

Question 6

How do you test for staphlococcus saprophyticus? (differentiate between other staph)

Answer 6

Gram positive cocci in clusters

Coagulase negative and to differentiate between coagulase negative staph carry out a novobiocin test

Staph Saprophyticus is novobiocin resistant

Question 7

What is the earliest stool of an infant known as?

Answer 7

Meconium

Question 8

meconium - first stool of a newborn

How long after birth before this is said to be delayed if it has not occured already?

Answer 8

Greater than 24 hours after birth

Question 9

What is a rare condition that can cause poo to get stuck in the intestine due to blockage?

Answer 9

Hirschsprung’s disease

Question 10

What can the constipation in Hirschsprung’s disease in chidlren lead to?

Answer 10

Can lead to enterocolitis

Question 11

In children presenting with abdominal pain, there is often no serious underlying medical cause

However give examples of important medical diagnoses not to overlook?

Answer 11

Coeliac’s disease

Inflammatory bowel disease

Malrotation
Volvulus (tisting off the gut causing obstruction - common caused by malrotation)

Question 12

What are the haplotypes of ceoliac disease?

Answer 12

HLADQ2 and HLADQ8

Question 13

What is the Rome IV criteria for diagnosing irritable bowel syndrome?

Answer 13

Recurrent abdominal pain or discomfort at least 1 day per week for the last 3 months, with symptom onset at least 6 months prior to diagnosis

Associated with 2 or more of the following

• Improvement with defecation
• Onset associated with a change in frequency of stool
• Onset associated with a change in form (appearance) of stool

Question 14

In the UK, the median symptom interval (time between symptom onset and diagnosis) for childhood brain tumours is approximately…….months?

Answer 14

Around 2.5 to 3 months

Question 15

What is the commonest kind of heart murmur in childhood?

Answer 15

Still’s murmur

Question 16

Ages 2-7

“Vibratory” low-frequency mid-systole murmur

Increases in intensity when pt is in supine position

louder in high output states (i.e. dehydration, fever)

What murmur?

Answer 16

Still’s murmur

Question 17

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

Answer 17

Asthma